title: Carotid angioplasty with stenting versus endarterectomy: 10-year randomized trial in a community hospital.
abstract: OBJECTIVE
  This single-center, randomized, clinical trial was designed to determine the 10-year comparative efficacy and durability of carotid angioplasty and stenting (CAS) versus carotid endarterectomy (CEA) in preventing ipsilateral ischemic stroke in symptomatic and asymptomatic patients with high-grade carotid artery stenosis.
  
  
  BACKGROUND
  Modern clinical trials with short-term follow-up indicate CAS and CEA are equivalent in reducing the risk for ipsilateral ischemic stroke secondary to carotid stenosis. A paucity of data exists regarding long-term outcomes.
  
  
  METHODS
  Patients of all surgical risks with symptomatic and asymptomatic carotid stenosis (>70%) were randomly selected for CEA or CAS and followed a minimum of 10 years.
  
  
  RESULTS
  Long-term follow-up was achieved in 173 patients (91%). Eighty-seven (50.2%) died within this period, most commonly of nonvascular causes. No difference in the risk of stroke ipsilateral to the treated artery was noted among treatment groups (p > 0.05). Restenosis determined by sequential ultrasound was assessed only in the CAS group (3.3%) and remained asymptomatic. The combined risk of fatal or nonfatal heart attack over the 10-year period was highest in individuals with symptomatic versus asymptomatic stenosis (27.5% vs. 11.0%; hazard ratio [HR]: 2.32, 95% confidence interval [CI]: 1.298 to 4.146, p = 0.005) and was higher in all patients treated with CEA (HR: 2.27, 95% CI: 1.35 to 3.816, p = 0.002).
  
  
  CONCLUSIONS
  Long-term protection against ipsilateral stroke provided by CAS and CEA did not differ in this trial. The 10-year risk of fatal/nonfatal myocardial infarction was highest in all patients harboring symptomatic carotid stenosis at enrollment. The risk of fatal/nonfatal heart attack was significantly more prevalent in those symptomatic or asymptomatic patients randomized to CEA.
authors.affiliation: Baptist Health Lexington, Lexington, Kentucky. Electronic address: william.brooks@bhsi.com.
authors.forename: William H
authors.initials: WH
authors.lastname: Brooks
authors.affiliation: Baptist Health Lexington, Lexington, Kentucky.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Jones
authors.affiliation: Baptist Health Lexington, Lexington, Kentucky.
authors.forename: Paula
authors.initials: P
authors.lastname: Gisler
authors.affiliation: Department of Cardiology, University of Kentucky, Lexington, Kentucky.
authors.forename: Rick R
authors.initials: RR
authors.lastname: McClure
authors.affiliation: Baptist Health Lexington, Lexington, Kentucky.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Coleman
authors.affiliation: Baptist Health Lexington, Lexington, Kentucky.
authors.forename: Linda
authors.initials: L
authors.lastname: Breathitt
authors.affiliation: Baptist Health Lexington, Lexington, Kentucky.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Spear
mesh_terms: D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D058070:Asymptomatic Diseases; D002545:Brain Ischemia / Q000209:etiology / Q000517:prevention & control; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D018572:Disease-Free Survival; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000401:mortality; D006764:Hospitals, Community; D006801:Humans; D053208:Kaplan-Meier Estimate; D007629:Kentucky; D009203:Myocardial Infarction / Q000209:etiology; D016016:Proportional Hazards Models; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome
keywords: 10-year randomized trial; carotid endarterectomy; carotid stenting; prevention of stroke