Periprocedural and Long-Term Outcomes of Carotid Stent Placement in Patients with Very Severe Carotid Artery Stenosis versus Carotid Near Occlusion with Full Collapse: A Propensity Score Matching Analysis

Abstract

Purpose

To compare the periprocedural and 5-year outcomes between patients with very severe stenosis (80%–99% stenosis) and those with carotid near occlusion (CNO) with full collapse.

Materials and Methods

Data from patients with very severe stenosis and CNO with full collapse who underwent carotid artery stent (CAS) placement at a single center were retrospectively analyzed from January 2018 to December 2021. Unmatched and propensity score-matched (PSM) comparisons of periprocedural adverse events and 5-year follow-up rates for in-stent restenosis, ipsilateral ischemic stroke, myocardial infarction, and mortality were conducted between the 2 groups.

Results

A total of 555 patients (481 patients in the very severe stenosis group and 74 in the CNO with full collapse group) were included. PSM resulted in 61 patients from the CNO group being matched with 183 from the severe stenosis control group. The periprocedural adverse events did not differ significantly between the 2 groups after PSM. The 5-year follow-up results demonstrated no significant differences in outcomes between the 2 groups. Kaplan–Meier curves showed that the 5-year rate of freedom from stroke was 89% (CNO group) versus 92% (control group; P = .500). The 5-year rate of freedom from in-stent restenosis was 89% (CNO group) versus 91% (control group; P = .630), while that from death, myocardial infarction, and stroke incidence was 84% (CNO group) versus 87% (control group; P = .430).

Conclusions

CNO with full collapse showed long-term outcomes comparable with those of very severe carotid stenosis following CAS placement.