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Title: Angioplasty With Stenting is an Alternative to Endarterectomy for Carotid Artery Stenosis
URL: http://www.pslgroup.com/dg/22AF86.htm
Doctor's Guide
September 5, 2008

NEW YORK -- September 5, 2008 -- Carotid angioplasty with stenting and endarterectomy show similar effectiveness for preventing ipsilateral stroke at 2 years and 4 years after the procedure in patients with symptomatic stenosis of the carotid artery, according to 2 studies published early online and in the October issue of The Lancet Neurology.

According to background information from the article, narrowing of the lumen of the carotid artery due to atheroma is a cause of transient ischaemic attacks and stroke. The standard treatment is endarterectomy.

However, stenting is less invasive, does not require general anaesthesia, and the length of stay in hospital is reduced. However, stenting does not remove the atheromatous plaque and also carries the risks of stroke, restenosis, and localised complications. The long-term efficacy of stenting has not been investigated.

In the first study, researchers from the Stent-Protected Angioplasty Versus Carotid Endarterectomy (SPACE) trial assessed the efficacy of stenting or endarterectomy in 1,214 patients in Germany, Austria, and Switzerland by measuring the rates of ipsilateral ischaemic stroke and restenosis up to 2 years after stenting or endarterectomy in a prospective, randomised clinical trial.

Reccurrence of the blockage to at least 70% of the vessel diameter, as assessed by ultrasound, was more common in the patients who had stenting (10.7%) than those who had surgery (4.6%).

However, the patients who had stenting were no more likely to have ipsilateral ischaemic stroke than were those who had surgery (9.5 vs 8.8%).

In the second study, the long-term follow up to the Endarterectomy Versus Angioplasty in Patients with Severe Symptomatic Stenosis (EVA-3S) trial, Researchers investigated 527 patients at 30 centres in France for a composite outcome of any stroke or death within 30 days of undergoing stenting (265 patients) or endarterectomy (262 patients) or any ipsilateral stroke up to 4 years after the procedures.

Although, overall, the patients who underwent stenting were twice as likely to have this composite outcome, stroke mostly occurred soon after the procedure (within 30 days), and there was no difference in the risk of ipsilateral stroke among patients who did not have a stroke within this postoperative period; therefore, stenting seems to be as effective as endarterectomy in the medium term.

The results of both trials seem to recommend stenting as an alternative treatment to endarterectomy in the medium term, but the risks of stroke and death need to be reduced in the crucial 30-day period after surgery, possibly through defining better criteria to select patients.

SOURCE: The Lancet Neurology

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