Comparative Outcomes of Carotid Endarterectomy and Carotid Artery Stenting: A Single-Center Experience

Abstract

Background

Carotid endarterectomy (CEA) is recommended as the standard revascularization strategy for patients with carotid stenosis, whereas carotid artery stenting (CAS) is generally reserved for high-risk surgical candidates. However, evidence comparing the safety and efficacy of both approaches in real-world practice remains heterogeneous.

Methods

We retrospectively analyzed 202 patients (mean age: 71.1 ± 8.5 years; 152 males, 75.2%) who underwent carotid revascularization at a single center between October 2016 and April 2025. Patients with symptomatic moderate-to-severe stenosis (50-99%) and asymptomatic severe stenosis (70-99%) were included. Based on the revascularization strategy, patients were divided into CEA (n = 67) and CAS (n = 135) groups. Periprocedural (30-day), 1 and 3-year outcomes including stroke, myocardial infarction (MI), and all-cause mortality were evaluated.

Results

Among patients, periprocedural stroke occurred in 4.5% of CEA patients and 2.2% of CAS patients (P = 0.653), MI in 1.5% and 0%, (P = 0.720), and all-cause mortality in 4.5% and 0.7% (P = 0.208) respectively. At 1-year follow-up, MI was significantly more frequent after CEA compared with CAS (8.6% vs 1.5%, P = 0.029), whereas stroke (8.6% vs 5.3%, P = 0.387) and all-cause mortality (10.3% vs 12.9%, P = 0.622) did not differ significantly. At 3 years, rates of stroke (12.3% vs 5.3%), MI (10.3% vs 3.8%), and all-cause mortality (22.4% vs 15.9%) were numerically higher in the CEA group, although these differences were not statistically significant. Subgroup analyses according to symptomatic status demonstrated no significant differences in 30-day, 1 or 3-year rates of stroke, MI, or all-cause mortality between the CEA and CAS groups.

Conclusion

In this single-center experience, CAS achieved peri-procedural and short-term outcomes comparable to CEA, despite being performed in a more frail and comorbid patient population. These findings suggest that CAS may represent a safe and effective alternative to CEA in high-risk surgical candidates when performed by experienced operators within a multidisciplinary framework.