title: Long-Term Outcome After Carotid Artery Stenting: A Population-Based Matched Cohort Study.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: From the Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, and Department of Surgery, Södersjukhuset, Stockholm, Sweden (M.J., P.G., J.M.); Institute of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden (D.L.); Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden (D.L.); and Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Sweden (A.W.). magnus.jonsson@sodersjukhuset.se.
authors.forename: Magnus
authors.initials: M
authors.lastname: Jonsson
authors.affiliation: From the Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, and Department of Surgery, Södersjukhuset, Stockholm, Sweden (M.J., P.G., J.M.); Institute of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden (D.L.); Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden (D.L.); and Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Sweden (A.W.).
authors.forename: David
authors.initials: D
authors.lastname: Lindström
authors.affiliation: From the Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, and Department of Surgery, Södersjukhuset, Stockholm, Sweden (M.J., P.G., J.M.); Institute of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden (D.L.); Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden (D.L.); and Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Sweden (A.W.).
authors.forename: Peter
authors.initials: P
authors.lastname: Gillgren
authors.affiliation: From the Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, and Department of Surgery, Södersjukhuset, Stockholm, Sweden (M.J., P.G., J.M.); Institute of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden (D.L.); Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden (D.L.); and Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Sweden (A.W.).
authors.forename: Anders
authors.initials: A
authors.lastname: Wanhainen
authors.affiliation: From the Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, and Department of Surgery, Södersjukhuset, Stockholm, Sweden (M.J., P.G., J.M.); Institute of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden (D.L.); Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden (D.L.); and Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Sweden (A.W.).
authors.forename: Jonas
authors.initials: J
authors.lastname: Malmstedt
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000150:complications / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D012042:Registries; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
keywords: carotid artery, common; cohort studies; endarterectomy, carotid; stenting; stroke