Tuesday, June 1, 2010

Tuesday June 1, 2010
Stenting versus Endarterectomy for Treatment of Carotid-Artery Stenosis

Background:
Carotid-artery stenting and carotid endarterectomy are both options for treating carotid-artery stenosis, an important cause of stroke.


Methods : We randomly assigned patients with symptomatic or asymptomatic carotid stenosis to undergo carotid-artery stenting or carotid endarterectomy.
The primary composite end point was stroke, myocardial infarction, or death from any cause during the periprocedural period or any ipsilateral stroke within 4 years after randomization.


Results: For 2502 patients over a median follow-up period of 2.5 years,

  • There was no significant difference in the estimated 4-year rates of the primary end point between the stenting group and the endarterectomy group
  • There was no differential treatment effect with regard to the primary end point according to symptomatic status
  • The 4-year rate of stroke or death was 6.4% with stenting and 4.7% with endarterectomy. The rates among symptomatic patients were 8.0% and 6.4%, and the rates among asymptomatic patients were 4.5% and 2.7% , respectively.
  • Periprocedural rates of individual components of the end points differed between the stenting group and the endarterectomy group: for death (0.7% vs. 0.3%, P=0.18), for stroke (4.1% vs. 2.3%, P=0.01), and for myocardial infarction (1.1% vs. 2.3%, P=0.03). After this period, the incidences of ipsilateral stroke with stenting and with endarterectomy were similarly low (2.0% and 2.4%, respectively; P=0.85).

Conclusions: Among patients with symptomatic or asymptomatic carotid stenosis, the risk of the composite primary outcome of stroke, myocardial infarction, or death did not differ significantly in the group undergoing carotid-artery stenting and the group undergoing carotid endarterectomy. During the periprocedural period, there was a higher risk of stroke with stenting and a higher risk of myocardial infarction with endarterectomy.



Stenting versus Endarterectomy for Treatment of Carotid-Artery Stenosis - Published at www.nejm.org May 26, 2010