Barbara Rantner1, Georg Goebel2, Leo Bonati3, Gustav Fraedrich1
1Department of Vascular Surgery, Innsbruck Medical University, Innsbruck, Austria; 2Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria; 3Department of Neurology and Stroke Unit, University Hospital Basel, Basel, Switzerland.
OBJECTIVES: Among patients with symptomatic carotid stenosis, carotid artery stenting (CAS) is associated with a higher risk of peri-procedural stroke or death than carotid endarterectomy (CEA). Uncertainty remains whether the balance of risks changes with time since the most recent ischemic event.
METHODS: We investigated the association of time since the qualifying event (0-7 days, 8-14 days, and >14 days after the qualifying event) with the risk of stroke or death within 30 days after CAS or CEA in a pooled analysis of data from individual patients randomized in the Endarterectomy vs. Angioplasty in patients with Symptomatic Severe Carotid Stenosis trial (EVA-3S), the Stent-Protected Angioplasty vs. Carotid Endarterectomy trial (SPACE), and the International Carotid Stenting Study (ICSS).
RESULTS: Timing information was available for 2,839 patients. In the first 30 days after intervention, any stroke or death occurred significantly more often in the CAS group (110 [7.7%] of 1,434) compared to the CEA group (54 [3.8%] of 1,405, crude risk ratio 2.0 [95% CI 1.5-2.7]. The timing of the intervention modified the treatment benefit: early treated CEA patients.
CONCLUSIONS: The increase in risk of CAS compared with CEA appears greatest in patients treated within 7 days of symptoms. This effect is also apparent independent of age.
AUTHOR DISCLOSURES: L. Bonati, Nothing to disclose; G. Fraedrich, Nothing to disclose; G. Goebel, Nothing to disclose; B. Rantner, Nothing to disclose.
Posted April 2012