May 28, 2010
Carotid Artery Stenting Almost Ready for Prime Time
Three months ago I wrote about carotid artery narrowing, which is one of a number of causes of stroke. There are currently two alternative treatments for severe carotid artery narrowing: surgery, called endarterectomy, to open the artery, and a newer procedure called carotid artery stenting. (Read my previous post, link below, for some background about these procedures and their role in stroke prevention.)
Thus far, carotid artery stenting has not been shown to be as safe as endarterectomy. So endarterectomy has remained the proven standard.
This week stenting finally gains some credibility in the largest study to compare the two treatments, published in this week’s New England Journal of Medicine. Over 2,500 patients with carotid artery narrowing were randomized to stenting or endarterectomy. They were followed for serious complications immediately after the procedure or for strokes in the subsequent years.
Surprisingly, the patients receiving stenting did overall as well as the patients undergoing endarterectomy, making this the first study in which endarterectomy was not clearly superior. Stenting carried a slightly higher risk of stroke after the procedure, but endarterectomy had a higher risk of heart attack. Interestingly, patients younger than 70 tended to do better with surgery, while older patients did better with stenting.
So stenting is finally finding some role in treating carotid artery narrowing. Training and experience in the physician performing either procedure is vital.
An editorial in the same issue of the New England Journal of Medicine concludes
… until more data are available, carotid endarterectomy remains the preferred treatment for most patients with symptomatic carotid stenosis; treatment for asymptomatic stenosis remains controversial. However, given the lack of significant difference in the rate of long-term outcomes, the individualization of treatment choices is appropriate.
New England Journal of Medicine article: Stenting versus Endarterectomy for Treatment of Carotid-Artery Stenosis
New England Journal of Medicine editorial: Carotid-Artery Stenting in Stroke Prevention
LA Times Booster Shots: Angioplasty plus stents is as good as surgery for clearing neck arteries, study finds
My previous post about carotid artery stenting: Carotid Stenting Still Controversial
Important legal mumbo jumbo: