Carotid artery stenosis caused by atherosclerosis is a major cause of cerebral infarction. When our hospital opened in 2001, carotid endarterectomy (CEA) was the first-line surgical treatment for carotid artery stenosis. However, since 2011, the number of carotid artery stenting (CAS) cases has gradually increased, making CAS an alternative treatment. This study compared the trends in the surgical treatment of carotid artery stenosis and the treatment outcomes of CEA and CAS over the past 20 years.

The mean age was 70.9 years in the CEA group and 75.1 years in the CAS group, with the CAS group being significantly older. There were no significant differences between the two groups in terms of sex, symptomatic rate, or degree of stenosis (NASCET). The rate of general anesthesia was 100% in the CEA group and 3.1% in the CAS group. The mean operative times were 178 min and 43 min, and the mean lengths of hospital stay were 16.9 days and 9.9 days, respectively, with CAS having significantly shorter operative times and hospital stays.

Regarding treatment outcome, the postoperative DWI-positivity rate was 6.5% in the CEA group and 38% in the CAS group, which was significantly higher than that in the CAS group. Conversely, the post-operative stroke rate measured using the modified Rankin scale (mRS) worsened in the CEA (1.6%) and CAS (1.5%) groups, with no significant difference. The restenosis rates requiring re-intervention were 3.1% and 3.7% in the CEA and CAS groups, respectively, again with no significant difference. However, the time to reintervention was significantly longer in the CEA group (43.9 months) than in the CAS group (12.4 months).

The mortality and morbidity rates over the past 20 years were similar for both procedures. Among the 550 CEA cases, 4 mortalities (0.7%) and 5 morbidities (0.9%) the 507 CAS cases, 0 mortalities (0%) and 4 morbidities (0.6%) were reported.