Carotid Artery Stenting versus Carotid Endarterectomy for Symptomatic or Asymptomatic Extracranial Carotid Stenosis: A National Cohort Study.

Stroke is now the 5th leading cause of death in the United States, and carotid artery stenosis is the cause of about 20% to 25% of strokes. We hypothesized that CAS maybe an alternative to CEA in both symptomatic and asymptomatic carotid artery stenosis patients. We evaluated the clinical characteristics, adverse events and mortality of carotid artery stenosis patients comparing CEA vs. CAS using data from a national population-based cohort study from January 1, 2016, to December 30, 2020. In our study, we evaluated 374,875 patients with carotid stenosis, of whom 344,020 had asymptomatic carotid stenosis and 30,855 had symptomatic carotid stenosis. CAS was associated with higher mortality in both symptomatic and asymptomatic carotid stenosis, compared to CEA, with the trend slightly decreasing for both interventions from the years 2018-2020. CEA was associated with lower adverse events in both symptomatic and asymptomatic carotid stenosis, compared to CAS. Our current data suggest a benefit of CEA over CAS for both symptomatic and asymptomatic carotid stenosis in terms of lower complications lower mortality and higher discharge rate. However, this is not a head-to-head comparison as it become selection bias for this procedure; therefore, further prospective study head-to-head comparison between 2 groups in the same patient population is needed.

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Déclaration de conflit d'intérêts

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.