Study reviews data on influence of contralateral carotid occlusion on CEA and CAS

Jun 11 2012

A new study, presented at the 66th Vascular Annual Meeting presented by the Society for Vascular Surgery® (SVS) reviewed data on the influence of contralateral carotid occlusion (CCO) on carotid endarterectomy (CEA) and carotid artery stenting (CAS) for which there is a paucity of conflicting data.

First author, Joseph J. Ricotta II, MD, MS, a SVS Outcomes Committee member, evaluated patients with and without CCO listed in the SVS Vascular Registry™. Primary outcome was a composite of periprocedural death, stroke, myocardial infarction (MI) or a major adverse cardiovascular event (MACE) and its individual components. Further analysis was done to identify the influence, if any, of symptom status on outcomes.

There were 1,128 CAS and 666 CEA patients with CCO. The CAS patients were more often symptomatic with a higher incidence of coronary artery disease, congestive heart failure, diabetes, chronic obstructive pulmonary disease, and NYHA >3. Absolute risk of periprocedural MACE (2.75 percent CAS vs. 4.20 percent CEA), death (1.06 percent CAS vs. 0.75 percent CEA), stroke (2.13 percent CAS vs. 3.15 percent CEA), and MI (0.35 percent CAS vs. 0.60 percent CEA), was statistically equivalent for both. This equivalence was maintained when patients with CCO were segregated by symptom status and after adjusting for peri-procedural risk.

There were 16,646 patients without contralateral occlusion (NCO) that included 5,698 CAS; 10,948 CEA. The NCO patients with CEA had better outcomes in a periprocedural MACE (1.76 percent NCO vs. 4.20 percent CCO) and stroke (1.06 percent NCO vs. 3.15 percent CCO) with a p<0.0001 for both. In CAS patients, CCO did not significantly affect a periprocedural MACE (3.16 percent NCO vs. 2.75 percent CCO), death (0.8 percent NCO vs. 1.0 percent CCO), stroke (2.3 percent NCO vs. 2.1 percent CCO) or MI (0.6 percent NCO vs. 0.3 percent CCO).

In CEA patients, CCO increased the incidence of MACE, primarily by increasing stroke rates in both asymptomatic (0.68 percent vs. 2.00 percent,>
According to the researchers, CEA is preferred in NCO patients regardless of symptom status. The benefit of CEA is lost in patients with CCO because of increased stroke rates, which did not occur with CAS and CCO. However, the results of CAS and CEA in patients with CCO are equivalent and within acceptable American Hospital Association guidelines.

Source: Society for Vascular Surgery