Late outcomes after carotid artery stenting versus carotid endarterectomy: insights from a propensity-matched analysis of the Reduction of Atherothrombosis for Continued Health (REACH) Registry.
BACKGROUND
In patients with carotid artery disease, carotid endarterectomy (CEA) and carotid stenting (CAS) are treatment options. Controversy exists as to the relative efficacy of the 2 techniques in preventing late events.


RESULTS
The Reduction of Atherothrombosis for Continued Health (REACH) Registry recruited > 68,000 outpatients ≥ 45 years of age with established atherothrombotic disease or ≥ 3 risk factors for atherothrombosis. Patients with CAS or CEA were chosen and followed up prospectively for the occurrence of cardiovascular events. Propensity score matching was performed to assemble a cohort of patients in whom all baseline covariates would be well balanced. Primary outcome was defined as death or stroke at the 2-year follow-up. Secondary outcome was stroke or transient ischemic attack. Tertiary outcome was a composite of death, myocardial infarction, or stroke and the individual outcomes. Of the 68 236 patients with atherothrombosis, 3412 patients (5%) had a history of carotid artery revascularization (70% asymptomatic carotid stenosis), 1025 (30%) with CAS and 2387 (70%) with CEA. Propensity score analyses matched 836 CAS patients with 836 CEA patients. At the end of 2 years of follow-up, in the propensity score-matched cohort, CAS was associated with a risk similar to CEA for the primary (hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.57 to 1.26), secondary (HR, 1.20; 95% CI, 0.73 to 1.96), and tertiary (HR, 0.72; 95% CI, 0.51 to 1.01) composite outcome, death (HR, 0.63; 95% CI, 0.40 to 1.00), and stroke (HR, 1.48; 95% CI, 0.79 to 2.80).


CONCLUSIONS
In a real-world cohort of patients with a history of carotid artery revascularization, CAS was comparable to CEA for late outcomes.
Bangalore
Sripal
S
The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY, USA.
Bhatt
Deepak L
DL
Röther
Joachim
J
Alberts
Mark J
MJ
Thornton
Julie
J
Wolski
Kathy
K
Goto
Shinya
S
Hirsch
Alan T
AT
Smith
Sidney C
SC
Aichner
Franz T
FT
Topakian
Raffi
R
Cannon
Christopher P
CP
Steg
P Gabriel
PG
D000368:Aged; D000369:Aged, 80 and over; D002340:Carotid Artery Diseases / Q000150:complications / Q000628:therapy*; D002341:Carotid Artery Thrombosis / Q000209:etiology / Q000517:prevention & control; D015331:Cohort Studies; D016894:Endarterectomy, Carotid; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D011446:Prospective Studies; D012042:Registries; D015607:Stents; D016896:Treatment Outcome