Stents Equal Surgery for Reducing Stroke Risk

Endarterectomy and stenting for correcting atherosclerosis in the carotid artery are equally effective in reducing the long-term risk of stroke, according to a new study.

Research at the Mayo Clinic (Jacksonville, FL, USA), the Medical University of South Carolina (Charleston, USA), and other institutions participating in the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST), followed 2,502 patients with narrowed carotid arteries (average age 69 years) who were randomly assigned to receive stenting or endarterectomy at 117 centers in the United States and Canada. Main outcomes and measures included periprocedural stroke, subsequent ipsilateral stroke, myocardial infarction (MI), and death.

The results showed no significant difference between the stenting group and the endarterectomy group with respect to the primary composite end point of stroke, MI, or death during the periprocedural period, or any subsequent ipsilateral stroke during ten years of follow-up. No significant between-group differences with respect to either end point were detected when symptomatic patients and asymptomatic patients were analyzed separately. The study was published on February 18, 2016, in the New England Journal of Medicine (NEJM).

“We have two safe procedures. We know now that they are very effective in the long run. Now the patient and the physician have the option to select surgery or stenting, based on that individual patient's medical condition and preferences,” said lead author Prof. Thomas Brott, MD, of the Mayo Clinic department of neurosciences. “Because seniors with carotid artery narrowing are living longer, the durability of stenting and surgery will be reassuring to the patients and their families.”

Endarterectomy is a surgical procedure to remove the atheromatous plaque material, or blockage, in the lining of an artery. The procedure is widely used on the carotid artery of the neck as a way to reduce the risk of stroke, particularly when the carotid artery is narrowed by more than 70%. In patients who are unsuitable for endarterectomy, stenting is the preferred option.

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Medical University of South Carolina