‘It works in practice, but does it work in theory?’ An important addition to the body of real-world evidence supporting carotid endarterectomy - Summary - MDSpire
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‘It works in practice, but does it work in theory?’ An important addition to the body of real-world evidence supporting carotid endarterectomy
To evaluate the long-term outcomes of carotid revascularization procedures (CEA and CAS) in a real-world setting and compare these findings with theoretical outcomes from randomized trials.
Approach:
Study Design: Analysis of 10-year nationwide practice patterns and outcomes after carotid revascularization using data from the French National Health Data System.
Patient Population: Included nearly 150,000 patients who underwent CEA or CAS with 9 years of follow-up.
Key Findings:
85% of patients had asymptomatic carotid stenosis; 15% were symptomatic.
30-day stroke or death risk was 1.5% for CEA and 3.0% for CAS in asymptomatic patients.
In symptomatic patients, the 30-day stroke or death risk was 11.4% for CEA and 14.2% for CAS.
At 5 years, CAS showed greater cumulative stroke and mortality risks compared to CEA in both groups.
98% of patients achieved postoperative medical therapy compliance.
Interpretation:
The study contrasts findings from the CREST-2 trial, which showed different outcomes due to stricter inclusion criteria.
Limitations:
Observational studies may be subject to biases and confounding.
Generalizability of randomized trial outcomes may be limited due to proceduralist experience.
Conclusion:
Real-world studies provide insights that complement randomized trials, particularly regarding the effectiveness of CEA compared to CAS.
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