Journal
CIRCULATION
Volume 122, Issue 11, Pages 1091-1100Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/CIRCULATIONAHA.109.933341
Keywords
carotid arteries; endarterectomy; prognosis; stents
Funding
- Sanofi-Aventis
- Bristol-Myers Squibb
- Waksman Foundation (Tokyo, Japan)
- Eisai
- Ethicon
- Heartscape
- The Medicines Co.
- Bayer vital
- Boehringer-Ingelheim
- Lundbeck
- Astellas
- Otsuka
- DaiichiSankyo
- Schering-Plough
- Schering-Plough, GlaxoSmithKline
- Novartis
- Teijin
- Towa-Eiyo
- Bayer
- Pfizer
- Banyu
- Mochida
- Johnson and Johnson
- Kowa
- Avot Vascular
- Tanabe Mitsubishi,
- Accumetrics
- InteKrin
- Merck
- Takeda
- Servier
- DaiichiSankyo-Lilly
- Medtronic
- Roche
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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. Methods and 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). Conclusion-In a real-world cohort of patients with a history of carotid artery revascularization, CAS was comparable to CEA for late outcomes. (Circulation. 2010;122:1091-1100.)
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