Neurointervention.  2019 Sep;14(2):82-90. 10.5469/neuroint.2019.00115.

Comparison of Long Term Prognosis between Carotid Endarterectomy versus Stenting; A Korean Population-Based Study Using National Insurance Data

• Seo KD
• Lee KY
• Suh SH

• KMID: 2458487
• DOI: http://doi.org/10.5469/neuroint.2019.00115

Abstract

PURPOSE
Although carotid endarterectomy (CEA) is recommended as a treatment for carotid stenosis rather than carotid artery stenting (CAS), CAS has been preferred in Korea. The aim of this study was to analyze long-term outcomes after CAS compared with CEA using Korean nationwide insurance data.
MATERIALS AND METHODS
We obtained all data from the nationwide database of the Health Insurance Review & Assessment Service (HIRA) during the study period using several codes regarding the procedure or operation. We included the HIRA data, which included at least one-year follow-up after the procedures. The outcomes associated with both procedures were death, recurrence of ischemic stroke, and admission for cerebral hemorrhage.
RESULTS
A total of 16,065 eligible patients who were treated with CAS or CEA between 1 January 2007 and 31 December 2016 were analyzed. The number of patients with CAS and CEA was 12,173 (75.8%) and 3,892 (24.2%), respectively. 8,976 patients (55.9%) were classified as symptomatic patients. CAS was associated with a higher risk of all-cause mortality (adjusted hazard ratio [HR], 1.282; 95% confidence interval [CI], 1.173-1.400). The adjusted rates for recurrent ischemic stroke and cerebral hemorrhage between CAS versus CEA were 24.9% versus 15.9% (HR, 1.474; 95% CI, 1.325-1.639) and 1.5% versus 0.9% (HR, 2.026; 95% CI, 1.322-3.106), respectively. In young symptomatic patients, there was no statistically significant difference in all-cause mortality and cardiovascular death between CAS and CEA.
CONCLUSION
Our study using Korean nationwide insurance data demonstrated similar results to previous studies. Until further evidence of CAS is established through prospective studies, CAS should be performed in selected patients according to current guidelines.

Keyword

Carotid stenosis; Endarterectomy; Stents; Population health

MeSH Terms

Carotid Arteries
Carotid Stenosis
Cerebral Hemorrhage
Endarterectomy
Endarterectomy, Carotid*
Follow-Up Studies
Humans
Insurance*
Insurance, Health
Korea
Mortality
Prognosis*
Prospective Studies
Recurrence
Stents*
Stroke

Figure

• 

  Fig. 1. Kaplan-Meier estimates of cumulative incidence of major outcomes. (A) All-cause mortality after treatment. (B) Cardiovascular death after treatment. (C) Ischemic stroke for >28 days after treatment. (D) Cerebral hemorrhage for >28 days after treatment. The numbers below the graph are the numbers of patients in each group who were event free and still at risk during follow-up period. CAS, carotid artery stenting; CEA, carotid endarterectomy.

• 

  Fig. 2. Adjusted hazard ratio for all-cause mortality in patients treated with CAS (relative to patients treated with CEA). CEA, carotid endarterectomy; CI, confidence interval; CAS, carotid artery stenting.

• 

  Fig. 3. Adjusted hazard ratio for cardiovascular death in patients treated with CAS (relative to patients treated with CEA). CEA, carotid endarterectomy; CI, confidence interval; CAS, carotid artery stenting.

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