LAUSR

Objectives: Carotid artery stenting (CAS) remains an effective alternative to carotid endarterectomy (CEA) for stroke prevention; however, the long-term durability of CAS remains poorly defined. We performed a 10-year comparative analysis of CEA and CAS to help better evaluate the durability of these procedures. Methods: This was a single-center retrospective review of 996 lesions treated with CEA or CAS from January 2001 through December 2011. Early and late death, stroke, and myocardial infarction (MI) event rates were analyzed over a mean follow-up of 54 months. Results: A total of 996 patients underwent CEA (n 1⁄4 787) or CAS (n 1⁄4 209) with embolic protection. Mean age (CEA 69.8 years vs CAS 71.0 years), gender distribution (CEA 63.7% men vs CAS 60.3% men), and symptomatic status (CEA 44.4% vs CAS 37.5%) did not differ significantly between the two groups. The 30-day, 5-year, and 10-year overall survival rates for patients following CEA were 99.0%, 77.9%, and 55%, respectively, compared to CAS rates: 99.5%, 67.8%, and 40% (P 1⁄4 .02), respectively. There was no significant difference in early stroke rates (CEA 1.4% vs CAS 1.7%) or MI rates (CEA 0.8% vs 1.0%) between the groups. Subgroup analysis comparing symptomatic status demonstrated no statistically significant differences in overall survival, stroke rates, or MI rates at 10 years. Interestingly, in addition to a reduction in long-term overall survival, CAS patients had a higher long-term restenosis rate compared to CEA (6.3% vs 2.8%; P < .0001). Conclusions: Early death, stroke, and MI rates are comparable after CEA and CAS. CAS is an effective means in preventing stroke among patients with carotid artery stenosis although it is associated with lower overall late survival and higher rates of restenosis. CEA continues to be the preferred long-term solution for extracranial carotid artery disease and is associated with better long-term survival and lower restenosis rates.