Endarterectomy, Stenting, or Medical Treatment for Symptomatic Carotid Near-Occlusion: Results from CAOS, a Multicenter Registry Study

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FIGURE.
Kaplan-Meier curves comparing the effect of CAS (green line), CEA (blue line), and medical treatment (black line) on the cumulative rate of ipsilateral ischemic stroke (A) and mortality (B).

Table 1:

Baseline characteristics of the patients

	CEA (n = 23)	CAS (n = 44)	Medical Treatment (n = 74)	P Value
Demographics
Age (mean) (SD) (yr)	68.6 (7.9)	68.4 (10.9)	69.0 (8.3)	.946
Age younger than 65 yr (No.) (%)	7 (30.4)	13 (29.5)	22 (31.1)	.985
Age 65–74 yr (No.) (%)	9 (39.1)	16 (36.4)	30 (40.5)	.904
Age 75 yr or older (No.) (%)	7 (30.4)	15 (34.1)	21 (28.4)	.809
Male sex (No.) (%)	19 (82.6)	39 (88.6)	62 (83.8)	.723
Time to revascularization
Days to revascularization, (median) (IQR)	22 (11–53)	21 (8−39.5)		.930
Revascularization within 15 days after the presenting event (No.) (%)	8 (34.8)	20 (45.5)		.400
Risk factors
Hypertension (No.) (%)	15 (65.2)	35 (79.5)	51 (68.9)	.352
Diabetes mellitus (No.) (%)	10 (43.5)	12 (27.3)	29 (39.2)	.311
Dyslipidemia (No.) (%)	13 (56.5)	21 (47.7)	39 (52.7)	.770
Current smoker (No.) (%)	9 (39.1)	17 (38.6)	23 (31.1)	.629
Ischemic heart disease (No.) (%)	2 (8.7)	8 (18.2)	13 (17.6)	.556
Atrial fibrillation (No.) (%)	0	1 (2.3)	6 (8.1)	.180
Previous stroke/TIA (No.) (%)^{^a}	4 (17.4)	11 (25)	20 (27)	.646
Peripheral artery disease (No.) (%)	3 (13)	5 (11.4)	5 (6.8)	.554
Clinical presentation
Ipsilateral ischemic stroke or retinal infarct (No.) (%)	17 (73.9)	31 (70.5)	47 (63.5)	.566
Ipsilateral transient symptoms (No.) (%)	6 (26.1)	13 (29.5)	27 (36.5)	.566
Ipsilateral recurrent events (No.) (%)	4 (17.4)	7 (15.9)	13 (17.6)	.972
Full collapse (No.) (%)^{^b}	5 (23.8)	10 (33.3)	26 (41.3)	.332

↵a The history of stroke/TIA before the index event.
↵b The presence or absence of full collapse could be determined in 114 patients.

Table 2:

Revascularization results, periprocedural complications, carotid imaging follow-up, and clinical follow-up

	CEA (n = 23)	CAS (n = 44)	Medical Treatment (n = 74)	P Value
Immediate results of the procedure
Complete revascularization	20 (87)	36 (81.8)		.360
Revascularization failure	3 (13)	8 (18.2)
Incomplete revascularization	2 (8.7)	6 (13.6)
ICA occlusion	1 (4.3)	2 (4.5)
Periprocedural complications
Ipsilateral stroke or TIA	3 (13)	3 (6.8)		.397
Disabling stroke	0	1 (2.3)
Nondisabling stroke	3 (13)	0
TIA	0	2 (4,5)
Death	0	0^{^a}
Periprocedural stroke or death	3 (13)	1 (2.3)		.077
Other complications	5 (21.7)	7 (15.9)		.555
Stent thrombosis	0	1 (2.3)
Cerebral hyperperfusion syndrome	1 (4.3)	1 (2.3)
Epileptic seizures	0	1 (2.3)
Complications in the puncture area	0	2 (4.5)
Hypoglossal nerve palsy/dysphonia	3 (13.6)	0
Asystolia/bradycardia	0	2 (4.5)
Airway compression	1 (4.3)	0
Carotid-imaging follow-up
Carotid restenosis or occlusion^{^b}	1 (4.5)	4 (10.5)		419
Carotid restenosis	0	3 (6.8)		.200
Symptomatic carotid restenosis	0	1^{^c}
Carotid occlusion	1 (4.8)	1 (2.3)		.636
Symptomatic carotid occlusion	0	1^{^d}
Clinical follow-up
Ipsilateral ischemic stroke at 24 months’ follow-up	4 (17.4)	2 (4.8)	9 (13.1)	.223
Mortality at 24 months’ follow-up	1 (4.5)	5 (12)	4 (5.6)	.422

↵a One patient had cerebral hyperperfusion syndrome and died 67 days after the procedure.
↵b Carotid imaging follow-up was performed in 62 patients (22 in the CEA group and 40 in the CAS group).
↵c Carotid restenosis manifested clinically as a TIA.
↵d Disabling ipsilateral stroke.

Table 3:

Factors related to revascularization failure, periprocedural stroke or death, and carotid restenosis

	Revascularization Failure		Periprocedural Stroke or Death		Carotid Restenosis or Occlusion at Follow-up
	Univariate Analysis	Multivariate Analysis^{^a}	Univariate Analysis	Multivariate Analysis^{^a}	Univariate Analysis	Multivariate Analysis^{^a}
Age 75 yr or older	1.91 (0.51–7.13)		2.15 (0.28–16.38)		3.66 (0.56–24.00)
Male sex	0.64 (0.12–3.61)		0.44 (0.04–4.72)
Hypertension	4.00 (0.47–33.86)		1.02 (0.10–10.53)
Diabetes mellitus	0.40 (0.08–2.03)		2.15 (0.28–16.38)		0.51 (0.05–4.94)
Dyslipidemia	0.30 (0.07–1.26)		0.97 (0.13–7.31)		1.56 (0.24–10.05)
Current smoker	0.54 (0.13–2.25)		1.63 (0.22–12.31)		1.00 (0.15–6.48)
Ischemic heart disease	2.63 (0.56–12.31)		2.00 (0.19–21.41)		1.71 (0.17–17.63)
Previous stroke/TIA	1.375 (0.32–6.00)		1.17 (0.11–12.11)		0.90 (0.09–8.78)
Clinical presentation as transient symptoms	0.37 (0.04–3.16)		1.42 (0.14–14.84)		3.41 (0.50–23.39)
Full collapse	8.50 (1.43–50.66)^{^b}	11.60 (1.59–84.63)^{^c}	0.79 (0.08–8.22)		9.27 (0.87–98.51)^{^d}	27.40 (1.32–567.74)^e
CEA vs CAS	0.68 (0.16–2.84)		6.45 (0.63–65.93)		0.41 (0.04–3.87)