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Carotid stenting comparable to carotid endarterectomy for long-term stroke prevention
De Rango P. J Am Coll Cardiol. 2011;57:664-671.
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For stroke prevention, carotid artery stenting can have similar 5-year outcomes to carotid endarterectomy, provided the physician uses sound judgment in choosing which technique to perform, according to a recent study.
Researchers prospectively tracked 1,118 patients who were treated by carotid endarterectomy (CEA) and 1,084 patients who underwent carotid artery stenting (CAS). Overall, 71% were men, and the mean age was 71.3 years. All of the patients were either more than 60% symptomatic or more than 70% asymptomatic for carotid stenosis. The choice of revascularization method was left to the treating physician. Typically, patients with known allergies to aspirin, clopidogrel, or contrast media and renal insufficiency were excluded from CAS, as were those patients with aortic arch anatomy, severe peripheral vascular disease precluding femoral access or extremely tortuous carotid anatomy. Patients with high-neck carotid bifurcation and long carotid lesions, as well as obese patients or those taking ongoing dual antiplatelet therapy, were generally excluded from CEA, according to the study.
Overall, 30-day stroke/death rates were 2.8% in the CAS group and 2% in the CEA group — a statistical similarity (P=.27). The risk of 30-day stroke or death was higher in symptomatic (3.5%) vs. asymptomatic (2%) patients (P=.04) but was statistically similar. At 5 years, survival rates were statistically similar between the two groups: 82% in CAS and 87.7% in CEA (P=.05). There were no sex- or age-related significant outcome differences, according to the study.
Per Kaplan-Meier estimates, the composite of any periprocedural stroke or death and ipsilateral stroke at 5 years after the procedure were similar in all patients (4.7% vs. 3.7%; P=.4). Kaplan-Meier estimates were similar for the subgroups of symptomatic (8.7% vs. 4.9%; P=.7) in CEA and asymptomatic (2.5% vs. 3.3%; P=.2) in CAS.
“When physicians use their clinical judgment to select the appropriate technique for carotid revascularization, CAS can offer efficacy and durability comparable to CEA with benefits persisting at 5 years,” the researchers concluded.
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