title: 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.
abstract: 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.
authors.affiliation: The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY, USA.
authors.forename: Sripal
authors.initials: S
authors.lastname: Bangalore
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.forename: Joachim
authors.initials: J
authors.lastname: Röther
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Alberts
authors.forename: Julie
authors.initials: J
authors.lastname: Thornton
authors.forename: Kathy
authors.initials: K
authors.lastname: Wolski
authors.forename: Shinya
authors.initials: S
authors.lastname: Goto
authors.forename: Alan T
authors.initials: AT
authors.lastname: Hirsch
authors.forename: Sidney C
authors.initials: SC
authors.lastname: Smith
authors.forename: Franz T
authors.initials: FT
authors.lastname: Aichner
authors.forename: Raffi
authors.initials: R
authors.lastname: Topakian
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Cannon
authors.forename: P Gabriel
authors.initials: PG
authors.lastname: Steg
mesh_terms: 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