Real-World Outcomes of Carotid Artery Stenting in Symptomatic and Asymptomatic Patients With Carotid Artery Stenosis

Kazutaka Uchida; Fumihiro Sakakibara; Nobuyuki Sakai; Koji Iihara; Hirotoshi Imamura; Akira Ishii; Yuji Matsumaru; Chiaki Sakai; Tetsu Satow; Kiyofumi Yamada; Manabu Shirakawa; Shinichi Yoshimura; JR-NET4 Study Group

doi:10.1016/j.jcin.2024.03.014

Real-World Outcomes of Carotid Artery Stenting in Symptomatic and Asymptomatic Patients With Carotid Artery Stenosis

JACC Cardiovasc Interv. 2024 May 13;17(9):1148-1159. doi: 10.1016/j.jcin.2024.03.014.

Affiliations

¹ Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan.
² Neurovascular Research and Neuroendovascular Therapy, Kobe City Medical Center General Hospital, Kobe, Japan.
³ Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan.
⁴ Department of Neurosurgery, Kyoto University, Kyoto, Japan.
⁵ Division of Stroke Prevention and Treatment, Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan.
⁶ Department of Neurosurgery, Kindai University, Osaka-Sayama, Japan.
⁷ Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan. Electronic address: hyogoneuro@yahoo.co.jp.

PMID: 38749596
DOI: 10.1016/j.jcin.2024.03.014

Abstract

Background: The effectiveness and safety of carotid artery stenting (CAS) are comparable to those of carotid endarterectomy in both symptomatic and asymptomatic patients with carotid artery stenosis, but real-world outcomes are not well-known.

Objectives: The purpose of this study was to investigate the real-world clinical outcomes of CAS in symptomatic and asymptomatic patients with carotid artery stenosis.

Methods: We conducted a nationwide retrospective registry study of 156 centers between January 2015 and December 2019. We enrolled consecutive patients with CAS managed by certified specialists from the Japanese Society of Neuroendovascular Therapy. Outcomes between symptomatic and asymptomatic patients were compared. The primary outcome was a composite of ischemic stroke and all-cause death at 30 days after CAS. Secondary outcomes were ischemic stroke, all-cause death, intracranial hemorrhage (ICH), and procedural complications.

Results: We analyzed 9,792 patients (symptomatic, n = 5,351; asymptomatic, n = 4,441). The mean age was 73.5 years, and men were dominant (86.4%). Embolism protection devices were used in 99% of patients. The primary outcome was not significantly different between the symptomatic and asymptomatic groups (120 [2.2%] vs 65 [1.5%]; adjusted OR: 1.30; 95% CI: 0.92-1.83). The incidences of symptomatic ICH, any ICH, acute in-stent occlusion, and hyperperfusion syndrome were significantly more prevalent in the symptomatic group (47 [0.9%] vs 8 [0.2%], aOR: 4.41 [95% CI: 1.68-11.6]; 73 [1.4%] vs 12 [0.3%], aOR: 3.56 [95% CI: 1.71-7.39]; 45 [0.8%] vs 19 [0.4%], aOR: 2.18 [95% CI: 1.08-4.40]; and 102 [1.9%] vs 36 [0.8%], aOR: 1.78 [95% CI: 1.17-2.71], respectively). Other secondary outcomes were not significantly different between the 2 groups.

Conclusions: The complication rate after specialist-involved CAS at 30 days was low in real-world practice.

Keywords: asymptomatic; carotid artery stenosis; carotid artery stenting; complication; outcome; symptomatic.

Publication types

Multicenter Study
Comparative Study
Observational Study

MeSH terms

Aged
Aged, 80 and over
Asymptomatic Diseases*
Carotid Stenosis* / complications
Carotid Stenosis* / diagnostic imaging
Carotid Stenosis* / mortality
Carotid Stenosis* / therapy
Endovascular Procedures* / adverse effects
Endovascular Procedures* / instrumentation
Endovascular Procedures* / mortality
Female
Humans
Intracranial Hemorrhages / etiology
Ischemic Stroke / etiology
Ischemic Stroke / mortality
Japan
Male
Middle Aged
Registries*
Retrospective Studies
Risk Assessment
Risk Factors
Stents*
Time Factors
Treatment Outcome