Carotid endarterectomy (CEA) is a safer revascularization strategy than carotid artery stenting (CAS) if performed two to seven days after an ischemic stroke or transient ischemic attack, according to a new study published in the European Journal of Vascular & Endovascular Surgery.
“Recency of the index event has been recognized as a key determinant of the effectiveness of revascularization, balancing the natural history risk of a second (more severe) event against the potential for a higher peri-procedural risk when carotid interventions are performed very early after the onset of symptoms,” wrote first author Andreia Coelho, a specialist at Hospital Geral de Santo António in Portugal, and colleagues. “The optimal timing for carotid revascularization, by either CEA or CAS, remains a matter for debate.”
Coelho et al. performed a systematic review and meta-analysis of 71 different studies that included nearly 233,000 symptomatic patients. All studies were originally completed from January 1995 to January 2021.
Articles published in a language other than English, case reports and literature reviews were excluded. Two reviewers screened each study independently of one another to confirm it met the team’s criteria.
Overall, CEA was associated with a lower 30-day risk of stroke or mortality than CAS when performed more than two days of symptom onset. According to one registry of more than 72,000 patients, patients presenting with a cerebral infarction experienced worse outcomes if revascularization occurred within two days of symptom onset.
Across all possible intervention timings, the team added, CAS was associated with higher stroke rates, though myocardial infarction rates were higher among CEA patients.
Reviewing the data, Coelho and colleagues concluded that expedited CEA “complies with the accepted thresholds in international guidelines.”
“The ideal timing for performing CAS (when indicated against CEA) is not yet defined,” they added. “Additional granular data and standard reporting of timing of intervention will facilitate future monitoring.”
Read the full study here.
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