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Long-Term Outcome After Carotid Artery Stenting: A Population-Based Matched Cohort Study
Karolinska Inst, Sodersjukhuset, Dept Clin Sci & Educ, Stockholm, Sweden.;Soder Sjukhuset, Dept Surg, Stockholm, Sweden..
Karolinska Inst, Inst Mol Med & Surg, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Vasc Surg, Stockholm, Sweden..
Karolinska Inst, Sodersjukhuset, Dept Clin Sci & Educ, Stockholm, Sweden.;Soder Sjukhuset, Dept Surg, Stockholm, Sweden..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
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2016 (English)In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 47, no 8, 2083-2089 p.Article in journal (Refereed) Published
Abstract [en]

Background and Purpose-Long-term outcome after carotid artery stenting (CAS), a less invasive technique than carotid endarterectomy (CEA), for prevention of stroke, is unclear. The aim was to assess long-term outcomes after CAS, compared with CEA, in a nationwide cohort study.

Methods-All patients registered in the national Swedish Vascular Registry (Swedvasc) treated with primary CAS between 2005 and 2012 were identified. For every CAS, 2 CEA controls, matched for sex, age, procedure year, and indication (symtomatic/asymtomatic), were chosen. Postoperative stroke was identified by cross-matching the cohort with the InPatient Registry and charts review. Primary end point was ipsilateral stroke or death >30 days postoperatively.

Results-A total of 1157 patients were included, 409 CAS and 748 CEA; 73% men with mean age 70 years and 69% were symptomatic. Risk factor profile was similar between the 2 groups. Median follow-up time was 4.1 years. Ipsilateral stroke or death of >30 days postoperatively occurred in 95 of 394 in the CAS group versus 120 of 724 in the CEA group (adjusted hazard ratio, 1.59; 95% confidence interval, 1.15-2.18). The corresponding adjusted rates for death, ipsilateral stroke of >30 days, and any stroke or death of >30 days were 25.7% versus 18.6% (hazard ratio, 1.20; 95% confidence interval, 0.84-1.72), 9.4% versus 2.9% (hazard ratio, 3.40; 95% confidence interval, 1.53-7.53), 34.2% versus 23.6% (hazard ratio, 1.49; 95% confidence interval, 1.10-2.00) for the CAS group versus CEA group, respectively.

Conclusions-In this nationwide cohort study, CAS was associated with an increased long-term risk of ipsilateral stroke and death during after the perioperative phase when compared with CEA.

Place, publisher, year, edition, pages
2016. Vol. 47, no 8, 2083-2089 p.
Keyword [en]
carotid artery, common, cohort studies, endarterectomy, carotid, stenting, stroke
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-303117DOI: 10.1161/STROKEAHA.116.013018ISI: 000380808400029PubMedID: 27406106OAI: oai:DiVA.org:uu-303117DiVA: diva2:1033015
Available from: 2016-10-05 Created: 2016-09-15 Last updated: 2017-11-30Bibliographically approved

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