Carotid stenting versus carotid surgery: a prospective cohort study.

PURPOSE: To compare the results of carotid stenting and carotid surgery in a consecutive group of 455 patients (482 lesions).

METHODS

Between January 1995 and July 2002, 107 patients (114 lesions) were treated with carotid stenting and 348 patients (368 lesions) with carotid surgery. A cerebral protection device was routinely used in the last 46 stent cases. All patients were followed with duplex examination at 1 and 6 months postoperatively and yearly thereafter.

RESULTS

The stent and surgery groups were similar in terms of mean age (70.5 and 71.1 years, respectively), sex distribution (men 72% versus 75%), and symptoms (transient ischemic attack [TIA] or minor stroke 32.7% versus 42.2%). Median follow-up was 15 months in stent patients and 14 months in the surgical group. At 1 month postoperatively, there were 7 minor strokes (5 temporary lasting <21 days and 2 persistent) and 1 major stroke in the stent group versus 1 persistent minor stroke in the surgical patients. The overall neurological event rate (including TIA) was 10.5% versus 1.9% (p=0.0002) in the surgical patients; cardiac morbidity was 3.5% versus 1.6% (p=NS), and the death rate was 0% versus 0.8% (p=NS). The combined permanent stroke/death rate was 2.6% in stent patients and 1.1% in surgery patients (p=NS). During follow-up, the cumulative all stroke rate was 8.8% versus 1.9% (p=0.001), but the 3-year cumulative survival rate free from ipsilateral major neurological events was 95.2% in stent patients and 96.9% in the surgery cohort (p=NS). There was a 7.5% rate of restenosis in stented arteries versus 1.4% in surgery patients (p=0.001).

CONCLUSIONS

This series showed encouraging and comparable major stroke and deaths rate of carotid stenting and carotid surgery. However, there was more restenosis in the stented group on midterm follow-up.