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Stenting caused more ischemic brain lesions than endarterectomy
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New data have indicated that stenting is associated with increased rates of both acute and persisting brain lesions when compared with endarterectomy in a cohort of patients with carotid stenosis.
The study was an investigation of predictive factors for acute and persisting periprocedural ischemic brain lesions in individuals with symptomatic carotid stenosis. Patients randomly assigned to stenting (n=124) or endarterectomy (n=107) in the International Carotid Stenting Study were included.
These patients were evaluated for acute lesions using diffusion-weighted imaging 1 to 3 days after treatment. Lesions persisting on fluid-attenuated inversion recovery were also evaluated at 1 month in 86 patients in the stenting group and 75 patients in the endarterectomy group.
Individuals in the stenting group were more likely to experience acute lesions than those in the endarterectomy group (RR=8.8; 95% CI, 4.4-17.5). Stenting also was associated with an increased risk for persisting lesions (RR=4.2; 95% CI, 1.6-11.1).
The qualifying event in stenting was acute lesion count as associated with age (by trend), stroke and being male. The qualifying event in endarterectomy was high systolic BP. White matter disease was a qualifying event in both groups.
Patients who underwent stenting experienced a lower rate of conversion from acute to persisting lesions (RR=0.4; 95% CI, 0.2-0.8). Acute lesion volume predicted the rate of conversion.
“Stenting caused more acute and persisting ischemic brain lesions than endarterectomy,” the researchers concluded. “However, the rate of conversion from acute to persisting lesions was lower in the stenting group, most likely attributable to lower acute lesion volumes.”
Disclosure: The researchers report financial disclosures with companies including Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, C.R. Bard, GlaxoSmithKline, Pfizer, Sanofi-Aventis, Servier, Shire and W.L. Gore.
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