Jeanwan Kang, Virendra I. Patel, Shankha Mukhopadhyay, Ashu Garg, Matthew R. Cambria, Mark F. Conrad, Glenn M. LaMuraglia, Richard P. Cambria
Massachusetts General Hospital, Boston, MA.
OBJECTIVES: Carotid angioplasty and stenting (CAS) has been proposed as alternative to carotid endarterectomy (CEA), but late outcomes are unknown. Late outcomes after CEA have not been examined in a contemporary series and such is the aim of the current study.
METHODS: This was a retrospective study of patients who had undergone CEA at a single institution between 01/01/1989 and 12/01/2005. Primary study end points were stroke and death. Secondary study end points were recurrent stenosis and reintervention. Kaplan-Meir analysis was used to create survival curves for the study end points. Multivariate models were created to identify variables associated with the study end points.
RESULTS: A total of 3,308 CEAs (mean age 71.1+8.9 years; 60.4% male; 31.3% symptomatic; 3.5% redo surgery; 49.2% primary closure) were performed during the study period with mean follow up of 5.1 years [0-21.9 years]. Thirty-day stroke and death rates were 2.0% (1.2% ipsilateral) and 1.3% (inclusive of CEA/CABG), respectively. Median survival was 8.2 years with 5, 10, and 15-year survival of 70%, 42%, and 19%, respectively. Five-, 10-, and 15-year (any) stroke-free survival were 93%, 85%, and 72%, respectively. Cox proportional hazards analysis showed diabetes (HR=1.90; p<.0001), coronary artery disease (HR=1.75; p<.0001), chronic obstructive pulmonary disease (HR=1.60; p=.0002), current smoking status (HR=1.41; p=.0011), male gender (HR=1.20; P=.04), and age at CEA (HR=1.07; p<.0001) to be predictive of death. Symptomatic disease (HR=1.83; p<.0001), diabetes (HR=1.75; p=.0004), and female gender (HR=1.61; p=.0013) were predictive of late stroke. Restenosis-free (moderate or severe) survival at 5, 10, and 15 years were 77%, 64%, and 47%, respectively, whereas reintervention-free survival at 5, 10, and 15 years were 97%, 93%, and 89%, respectively.
CONCLUSIONS: CEA is associated with favorable long-term clinical and anatomic outcomes. These data may serve as a standard to compare late outcomes of CAS.
AUTHOR DISCLOSURES: M. R. Cambria, Nothing to disclose; R. P. Cambria, Nothing to disclose; M. F. Conrad, Nothing to disclose; A. Garg, Nothing to disclose; J. Kang, Nothing to disclose; G. M. LaMuraglia, Nothing to disclose; S. Mukhopadhyay, Nothing to disclose; V. I. Patel, Nothing to disclose.
Posted April 2012