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Endarterectomy outperformed stenting for symptomatic carotid stenosis
Endarterectomy yielded lower 5-year ipsilateral stroke rates than stenting in a cohort of patients with severe symptomatic carotid stenosis, concluded recent findings published in the journal Stroke.
The aim of the randomized controlled EVA-3S trial was to compare the long-term risk-benefit ratio of carotid stenting with endarterectomy for symptomatic carotid stenosis in 527 patients who were treated at 30 centers in France.
A composite of any ipsilateral stroke after randomization or any procedural stroke or death served as the primary outcome measure.
Clinicians followed patients for a median follow-up duration of 7.1 years (interquartile range, 5.1-8.8 years; maximum, 12.4 years). During this period, 30 patients in the stenting group and 18 patients in the endarterectomy group experienced the primary endpoint.
At 5 years, the cumulative probability of the primary endpoint was 11% (95% CI, 7.9-15.2) in the stenting group and 6.3% (95% CI, 4.0-9.8) in the endarterectomy group (HR=1.85; 1-3.4). At 10 years, the probability of this outcome was 11.5% (95% CI, 8.2-15.9) for stenting vs. 7.6% (95% CI, 4.9-11.8) for endarterectomy (HR=1.70; 0.95-3.06).
Rates of ipsilateral stroke were similar in both treatment groups after the procedural period. There were also no differences reported beyond the procedural period with regard to severe carotid restenosis (≥70%) or occlusion, death, MI or revascularization procedures.
“The long-term benefit-risk balance of carotid stenting vs. endarterectomy for symptomatic carotid stenosis favored endarterectomy, a difference driven by a lower risk of procedural stroke after endarterectomy,” the researchers concluded.
Disclosure: The researchers report no relevant financial disclosures.