Introduction: According to the current guidelines, treatment for carotid stenosis with carotid endarterectomy (CEA) or carotid artery stenting (CAS) should be limited to patients with life expectancy of >3 to 5 years. We aimed to assess the long-term survival after CEA and CAS in Japanese population.
Methods: Between August 2006 and June 2015, 262 consecutive carotid revascularizations with either CEA or CAS were performed in our institute. The initial treatment was regarded as the starting point in the cases of the patients who received treatment by bilateral carotid artery stenosis or retreatment. A Kaplan-Meier life table was done and a multivariate Cox hazard model was built for the analysis of the long-term survival-associated risk factors.
Results: A total of 231 patients (CEA 142, CAS 89; mean age, 72.1 ± 7.4 y.o.), including 106 symptomatic patients, were enrolled in the current study with mean follow-up period of 52.2 months. During follow-up 37 patients (16%) died, being cancer (19%) and pneumonia (19%) the most frequent causes. Cumulative 3- and 5-year survival rates were 92% and 87%, respectively. Kaplan-Meier estimates of the 5-year survival rate were 89.8% for CEA and 81.5% for CAS (P=0.033) (Figure Left). Cox regression model showed independent risk factors related to survival were age (Hazard ratio [HR], 1.08/year [95%CI, 1.03-1.13]; p = 0.003) (Figure Right)and CAS (HR, 2.3 [95%CI, 1.2-14.6]; p = 0.012). Presence of symptom was not associated with the long-term survival. No death due to stroke occurred.
Conclusion: The life-expectancy of patients in the current study satisfies the current guidelines and the long-term survival was associated with age and CAS. The inclusion of higher risk patients in the CAS group may have been the reason for CAS being a risk factor.