Carotid artery bypass versus endarterectomy as an alternative treatment of carotid artery stenosis: A propensity score matching analysis

Abstract

Objectives: The main focus of this study is to evaluate the reliability and durability of saphenous vein bypass grafting from common carotid artery to internal carotid artery (CBG) asan alternative treatment of patients with carotid artery stenosis.

Methods: 459 patients with carotid artery stenosis underwent initial carotid endarterectomy (CEA) or CBG between 2009 and 2019. Propensity score matching was performed, and outcomes of two different surgical procedures were analyzed.

Results: Outcomes of the 142 pairs of matched patients were investigated. There were no significant differences in the preoperative characteristics of these matched groups. Overall mean time of follow-up was 91.364 ± 3.265 months. Mortality rate during the follow-up period was 18.309% (26 patients) in the CEA group, and 11.971% (17 patients) in the CBG group. Stroke was encountered in 8 patients in the CEA group (5.63%), and 3 patients in the CBG group (2.11%) during follow-up. Restenosis was detected in 11 patients in the CEA group (7.75%), and 3 patients in the CBG group (3.52%) during follow-up. There were no significant differences in the survival, stroke - free survival, and restenosis - free survival distributions of both groups.

Conclusions: In carotid artery stenosis, it is reasonable to consider CBG as an alternative surgical option when adequate disease-free inflow (common carotid artery) and outflow (distal internal carotid artery) segments are present.

Keywords: Carotid artery bypass; Carotid artery stenosis; Carotid endarterectomy; Stroke.