Carotid Stenting and Endarterectomy

Abstract

Background and Purpose — Investigational carotid stenting for extracranial carotid stenosis has demonstrated procedural results approaching those reported with endarterectomy, but with limited cost and long-term data. This study compared the in-hospital outcomes and costs of these 2 revascularization strategies at a single institution and the long-term effectiveness of carotid stenting. Methods — Data for 136 endarterectomies and 136 carotid stent procedures at a tertiary-care community hospital were obtained. The primary clinical outcome measures were in-hospital major ipsilateral stroke and death. In-hospital direct variable costs and length of stay were the primary economic measures. Information on restenosis and late ipsilateral stroke for the stent group was available at 2-year follow-up. Results — These nonrandomized groups were similar, but the endarterectomy group had more symptomatic patients (42% versus 31%; P =0.0004), and the stent group had more NASCET-excluded patients (68% versus 35%; P <0.0001). In-hospital major ipsilateral stroke and death occurred more frequently in the surgical group, but the difference was not significant (2.9% versus 0%; P =0.1). Minor ipsilateral strokes were similar (2.2% versus 2.9%; P =NS). Cost ($5409 versus $3417; P <0.0001) and length of stay (3.0 versus 1.4 days; P <0.0001) were significantly greater for the surgical group. In the stent group, 6-month angiographic restenosis was 3.1%, and 2-year ipsilateral major stroke rate was 0%. Conclusions — In-hospital outcomes with carotid stenting were similar to those with endarterectomy but were achieved in patients with significantly more comorbidities. Cost and resource utilization with stenting were substantially less than those with endarterectomy. At 2 years, carotid stenting appeared not only durable but also effective in stroke prevention.