title: Carotid stenting versus endarterectomy for the treatment of carotid artery stenosis: Contemporary results from a large single center study.
abstract: OBJECTIVE
  To compare the complication rates associated with carotid endarterectomy (CEA) versus carotid artery stenting (CAS).
  
  
  BACKGROUND
  Carotid stenosis is a well-known cause of stroke and increased mortality. The safety of carotid revascularization may be related to symptom status, medical comorbidities, use of embolic protection devices, as well as operator experience and these factors may vary across patient populations within a single operating center.
  
  
  METHODS
  We retrospectively analyzed patients with carotid artery stenosis admitted to our hospital for carotid revascularization between January 1, 2007 and December 1, 2013. The primary end point was a composite endpoint of periprocedural death, stroke, and myocardial infarction (MI).
  
  
  RESULTS
  Of the 718 patients admitted for carotid revascularization 525 (73.1%) underwent CEA and 193 (26.9%) underwent CAS. Both groups demonstrated similar rates of the composite endpoint, MI, and death; the stenting group demonstrated a higher rate of stroke (4.2% vs. 1.3%; P = 0.020). Adjusting for baseline medical comorbidities and symptom status mitigated this difference (P = 0.091 and 0.113, respectively). When stratified by department performing CAS, there was a significant difference in the occurrence of stroke (P = 0.033), which likewise disappeared in the multivariate regression analysis.
  
  
  CONCLUSIONS
  The risk of the composite endpoint did not differ significantly between those undergoing CAS versus CEA. The stenting group demonstrated a higher rate of periprocedural stroke, which was also apparent when patients were stratified by stenting department. These differences were likely driven by variation in baseline medical comorbidities and symptom status. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Meller
authors.affiliation: Department of Internal Medicine, University of Connecticut, Farmington, Connecticut.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Salim Al-Damluji
authors.affiliation: Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Alejandra
authors.initials: A
authors.lastname: Gutierrez
authors.affiliation: Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Erik
authors.initials: E
authors.lastname: Stilp
authors.affiliation: Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Carlos
authors.initials: C
authors.lastname: Mena-Hurtado
mesh_terms: D000368:Aged; D000792:Angiography; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000601:surgery*; D016893:Carotid Stenosis / Q000175:diagnosis / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
keywords: carotid artery revascularization; carotid artery stenosis; endovascular therapy