Abstract 4418: Carotid Endarterectomy versus Carotid Artery Stenting: Insights From a Propensity Matched Analysis of the REduction of Atherothrombosis for Continued Health (REACH) Registry
Background: In patients with carotid artery disease, carotid endarterectomy (CEA) and carotid stenting (CAS) are treatment options for revascularization. Controversy exists as to the relative efficacy of the two techniques at preventing long-term events. The data comparing CEA and CAS in a real world setting is limited.
Methods: The REACH Registry recruited >68000 outpatients aged >=45 years with established atherothrombotic disease or >=3 risk factors for atherothrombosis. Patients with either CEA or CAS were chosen for this analysis. Patients were followed prospectively for the occurrence of cardiovascular events. Propensity score matching was performed to assemble a cohort of patients in which all baseline covariates would be well balanced. Primary outcome was defined as death or stroke at 2-year follow-up. Secondary outcome was stroke or transient ischemic attack (TIA).
Results: From the registry of 68,236 patients with atherothrombosis, 3412 (5%) patients underwent carotid artery revascularization, 2387 (70%) with CEA and 1025 (30%) with CAS. Propensity score analyses matched 838 CEA patients with 838 CAS patients. At the end of 2 years of follow-up, in the propensity adjusted cohort, CAS resulted in similar risk for primary (HR=0.90, 95% CI 0.63–1.27; P=0.54) (Figure⇓) and secondary outcomes (stroke/TIA) (HR=1.13, 95% CI 0.73–1.75; P=0.59) when compared to CEA.
Conclusions: In a real world cohort of patients undergoing carotid artery revascularization, carotid artery stenting was as efficacious as carotid endarterectomy for the prevention of long-term cardiovascular outcomes.