‘Real-world’ CAS and CEA late outcomes comparable

7 September 2010

MedWire News: Patients treated with carotid artery stenting (CAS) or carotid endarterectomy (CEA) in clinical practice have similar stroke or death rates for up to 2 years after the intervention, shows a analysis of the REACH registry.

The findings are consistent with the long-term outcomes in CREST (Carotid Revascularization Endarterectomy vs Stenting Trial), which followed-up patients for 4 years and found that, after the periprocedural period, stroke rates were similar in patients treated with CAS and CAS.

Deepak Bhatt (Brigham and Women’s Hospital, Boston, Massachusetts, USA) and colleagues identified 3412 patients from the REACH (Reduction of Atherothrombosis for Continued Health) registry who had undergone carotid revascularization. Of these, 1025 underwent CAS and 2387 underwent CEA.

From these patients, the team selected 836 CAS patients who could be propensity-matched with 836 CEA patients. The propensity scores used in the analysis were based on 23 variables including age; gender; history of stroke, transient ischemic attack (TIA), or myocardial infarction; smoking status; and use of various medications.

Among the matched patients, 2-year stroke and death rates were 9.9% and 8.9% after CAS and CEA, respectively, which were not significantly different. The corresponding stroke and TIA rates were 5.5% and 5.0%.

In subgroup analyses, patients older than 71 years had lower rates of stroke and death (but not of stroke/TIA) if they were treated with CAS rather than CEA.

Bhatt et al note that the long-term risk was similar after CAS and CEA despite CAS patients having more comorbidities than those treated with CEA.

“Thus, CAS may be considered a reasonable alternative in patients who are poor surgical candidates,” they write in the journal Circulation.

Finally, the researchers say that REACH gives “valuable insight” into real-world practice patterns, showing, for example, that most carotid artery revascularization is performed in asymptomatic patients.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

Circulation 2010; Advance online publication