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Meta-analysis Shows Poorer Results With Carotid-Artery Stenting Versus Endarterectomy: Presented at ACS

By John Gever

NEW ORLEANS, LA -- October 11, 2007 – Carotid-artery angioplasty and stenting is no better, and may in fact be less effective, than surgical endarterectomy for treating carotid-artery stenosis, according to research reported here at the 93rd Annual Clinical Congress of the American College of Surgeons (ACS).

A meta-analysis of published efficacy data for the two types of procedure, conducted by Anselm Wong, MD, surgical resident, Caritas St. Elizabeth's Medical Center and Tufts University School of Medicine, Boston, Massachusetts, United States, and colleagues was presented here on October 9th in a poster session.

Angioplasty and stenting have become more popular in recent years for treating carotid-artery stenosis (the leading cause of ischaemic stroke). This popularity may have arisen because angioplasty and stenting seem less disruptive than endarterectomy, and because the analogous procedure for coronary-artery stenosis has been very successful. Comparative studies in the carotid setting, however, have yielded mixed results.

This analysis covered five randomised, controlled trials that enrolled an aggregate of more than 2,700 patients. Dr. Wong said the analysis was limited to three main efficacy measures -- incidence of death, disabling stroke, and any stroke -- which were reported consistently in the covered trials. Treatment-related complications and other safety issues were not examined in the meta-analysis because the five studies treated them in different ways, he said.

With a composite endpoint of death and any stroke within 30 days of treatment, the meta-analysis indicated that the combination of angioplasty and stenting was significantly less effective than endarterectomy. These negative outcomes occurred in 8.5% of stented patients versus 6.5% of those undergoing endarterectomy (P =.05). Nonsignificant trends toward poorer efficacy of stenting were seen for a composite of death and disabling stroke, and for disabling stroke alone.

The poster noted that additional randomised trials are now underway that may shed additional light on the procedures' relative utility and adverse effects. In the meantime, the researchers noted that "stenting of carotid stenosis has yet to reach similar benefit to surgical intervention," and endarterectomy continues to be the "gold standard" for treating the condition.


[Presentation title: Surgical Endarterectomy Reduces Death or Stroke Compared with Endovascular Stenting for Carotid Artery Stenosis: A Meta-Analysis of 2,700 Patients.]

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