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Observational Study
. 2024 May 13;17(9):1148-1159.
doi: 10.1016/j.jcin.2024.03.014.

Real-World Outcomes of Carotid Artery Stenting in Symptomatic and Asymptomatic Patients With Carotid Artery Stenosis

Kazutaka Uchida  1 , Fumihiro Sakakibara  1 , Nobuyuki Sakai  2 , Koji Iihara  3 , Hirotoshi Imamura  3 , Akira Ishii  4 , Yuji Matsumaru  5 , Chiaki Sakai  2 , Tetsu Satow  6 , Kiyofumi Yamada  3 , Manabu Shirakawa  1 , Shinichi Yoshimura  7 ; JR-NET4 Study Group
Affiliations
Observational Study

Real-World Outcomes of Carotid Artery Stenting in Symptomatic and Asymptomatic Patients With Carotid Artery Stenosis

Kazutaka Uchida et al. JACC Cardiovasc Interv. .

Abstract

Background: The effectiveness and safety of carotid artery stenting (CAS) are comparable to those of carotid endarterectomy in both symptomatic and asymptomatic patients with carotid artery stenosis, but real-world outcomes are not well-known.

Objectives: The purpose of this study was to investigate the real-world clinical outcomes of CAS in symptomatic and asymptomatic patients with carotid artery stenosis.

Methods: We conducted a nationwide retrospective registry study of 156 centers between January 2015 and December 2019. We enrolled consecutive patients with CAS managed by certified specialists from the Japanese Society of Neuroendovascular Therapy. Outcomes between symptomatic and asymptomatic patients were compared. The primary outcome was a composite of ischemic stroke and all-cause death at 30 days after CAS. Secondary outcomes were ischemic stroke, all-cause death, intracranial hemorrhage (ICH), and procedural complications.

Results: We analyzed 9,792 patients (symptomatic, n = 5,351; asymptomatic, n = 4,441). The mean age was 73.5 years, and men were dominant (86.4%). Embolism protection devices were used in 99% of patients. The primary outcome was not significantly different between the symptomatic and asymptomatic groups (120 [2.2%] vs 65 [1.5%]; adjusted OR: 1.30; 95% CI: 0.92-1.83). The incidences of symptomatic ICH, any ICH, acute in-stent occlusion, and hyperperfusion syndrome were significantly more prevalent in the symptomatic group (47 [0.9%] vs 8 [0.2%], aOR: 4.41 [95% CI: 1.68-11.6]; 73 [1.4%] vs 12 [0.3%], aOR: 3.56 [95% CI: 1.71-7.39]; 45 [0.8%] vs 19 [0.4%], aOR: 2.18 [95% CI: 1.08-4.40]; and 102 [1.9%] vs 36 [0.8%], aOR: 1.78 [95% CI: 1.17-2.71], respectively). Other secondary outcomes were not significantly different between the 2 groups.

Conclusions: The complication rate after specialist-involved CAS at 30 days was low in real-world practice.

Keywords: asymptomatic; carotid artery stenosis; carotid artery stenting; complication; outcome; symptomatic.

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Conflict of interest statement

Funding Support and Author Disclosures This study was supported in part by a research grant from the Japanese Society of Neuroendovascular Therapy and the Kobayashi Foundation. Dr Uchida has received lecturer fees from Daiichi-Sankyo, Bristol Myers Squibb, Stryker, and Medtronic. Dr Sakakibara has received a manuscript fee from Medicus Shuppan. Dr N. Sakai has received a research grant from Biomedical Solutions, Medtronic, Terumo, and TG Medical; has received lecturer fees from Asahi-Intec, Biomedical Solutions, Daiichi-Sankyo, Kaneka, Medtronic, and Terumo; and has served on the Advisory Boards for Johnson & Johnson, Medtronic, and Terumo outside the submitted work. Dr Iihara has received a research grant from Idorsia Pharmaceutical Japan outside the submitted work. Dr Imamura has received lecturer fees from Medtronic, Daiichi Sankyo, Stryker, Johnson & Johnson, Terumo, and Asahi Intecc. Dr Ishii has received a research grant from Fuji Film; and has received lecture fees from Medtronic, Stryker, Terumo, and Johnson & Johnson. Dr Matsumaru has received lecturer fees from Medtronic, Stryker, Terumo, Kaneka, Biomedical Solution, E.P. Medical, B Braun, Daiichi-Sankyo, and Idorsia Pharmaceutical Japan outside of the submitted work. Dr Satow has received research grants from Canon Medical Systems; has received lecturer fees from Medtronic; and has received consulting fees from Kaneka Medix. Dr Yamada has received a research grant from the Terumo Life Science Foundation; and has received lecturer fees from Johnson & Johnson and Daiichi-Sankyo. Dr Shirakawa has received lecturer fees from Stryker, Terumo, Johnson & Johnson, and Medtronic. Dr Yoshimura has received research grants from Medico’s Hirata, Medtronic, and Terumo; and has received lecturer fees from Medtronic, Kaneka, Stryker, Daiichi-Sankyo, Bristol Myers Squibb, and Johnson & Johnson. Dr C. Sakai has reported that she has no relationships relevant to the contents of this paper to disclose.

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