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Comparison of Long Term Prognosis between Carotid Endarterectomy versus Stenting; A Korean Population-Based Study Using National Insurance Data

Authors
 Kwon-Duk Seo  ;  Kyung-Yul Lee  ;  Sang Hyun Suh 
Citation
 Neurointervention, Vol.14(2) : 82-90, 2019 
Journal Title
 Neurointervention 
ISSN
 2093-9043 
Issue Date
2019
Keywords
Carotid stenosis ; Endarterectomy ; Population health ; Stents
Abstract
PURPOSE: Although carotid endarterectomy (CEA) is recommended as a treatment for carotid stenosis rather than carotid artery stenting (CAS), CAS has been preferred in Korea. The aim of this study was to analyze long-term outcomes after CAS compared with CEA using Korean nationwide insurance data. MATERIALS AND METHODS: We obtained all data from the nationwide database of the Health Insurance Review & Assessment Service (HIRA) during the study period using several codes regarding the procedure or operation. We included the HIRA data, which included at least oneyear follow-up after the procedures. The outcomes associated with both procedures were death, recurrence of ischemic stroke, and admission for cerebral hemorrhage. RESULTS: A total of 16,065 eligible patients who were treated with CAS or CEA between 1 January 2007 and 31 December 2016 were analyzed. The number of patients with CAS and CEA was 12,173 (75.8%) and 3,892 (24.2%), respectively. 8,976 patients (55.9%) were classified as symptomatic patients. CAS was associated with a higher risk of all-cause mortality (adjusted hazard ratio [HR], 1.282; 95% confidence interval [CI], 1.173-1.400). The adjusted rates for recurrent ischemic stroke and cerebral hemorrhage between CAS versus CEA were 24.9% versus 15.9% (HR, 1.474; 95% CI, 1.325-1.639) and 1.5% versus 0.9% (HR, 2.026; 95% CI, 1.322-3.106), respectively. In young symptomatic patients, there was no statistically significant difference in all-cause mortality and cardiovascular death between CAS and CEA. CONCLUSION: Our study using Korean nationwide insurance data demonstrated similar results to previous studies. Until further evidence of CAS is established through prospective studies, CAS should be performed in selected patients according to current guidelines.
Files in This Item:
T201904518.pdf Download
DOI
10.5469/neuroint.2019.00115
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
Yonsei Authors
Suh, Sang Hyun(서상현) ORCID logo https://orcid.org/0000-0002-7098-4901
Lee, Kyung Yul(이경열) ORCID logo https://orcid.org/0000-0001-5585-7739
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/173343
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