Internal carotid artery stenosis - angioplasty with stenting or endarterectomy? A restrospective, single-center, observational study

Introduction: Carotid artery stenosis is one ofthe main causes of ischemic stroke globally. Carotid revascularization (stenting or endarterectomy) has proved to be an effective form of treatment, superior to medical therapy alone in stroke prevention. Aim: This study aimed to investigate the impact of carotid artery stenting (CAS) vs carotid artery endarterectomy (CEA) on outcomes in patients treated for unilateral internal carotid artery (ICA) stenosis. Methods: Between January 2021 and December 2021, 131 patients with stenosed unilateral ICA undergoing primary isolated ICA intervention were retrospectively analyzed. Patients were divided into two groups, those who underwent CEA (n = 87) and those who underwent CAS (n = 44). Propensity score matching (PSM) selected 35 pairs and both groups were comparable for all baseline characteristics and well balanced. Results: In the unmatched cohort, CEA and CAS had comparable long-term outcomes in terms of mortality. Survival at 12, 24, and 36 months was 95.4 vs 95.5%, 92.0 vs 95.5%, and 92.0 vs 95.5%, respectively (p Log-rank = 0.47). However, CEA was associated with a reduced incidence of stroke at follow-up. Freedom from stroke at 12, 24, and 36 months was 98.9 vs 90.9%, 97.6 vs 86.2%, and 97.6 vs 86.2%, respectively (p Log-rank = 0.011). In the matched cohort, CEA and CAS had comparable long-term outcomes in terms of mortality. Survival at 12, 24, and 36 months was 94.3 vs 94.3%, 91.4 vs 94.3%, and 91.4 vs 94.3%, respectively (p Log-rank = 0.65). However, CEA was associated with a reduced incidence of stroke at follow-up. Freedom from stroke at 12, 24, and 36 months was 100 vs 91.4%, 100 vs 85.5%, and 100 vs 85.5%, respectively (p Log-rank = 0.024). Conclusions: The present PSM study showed that, in patients with isolated unilateral ICA stenosis, CEA was associated with a reduced incidence of stroke compared to CAS.