Stenting Noninferior to Endarterectomy in Asymptomatic Carotoid Stenosis
HealthDay News — For patients with carotid artery stenosis, short- and long-term follow-up indicate that stenting has similar outcomes to endarterectomy, according to two studies published online February 18 in the New England Journal of Medicine. The research was published to coincide with the annual American Stroke Association's International Stroke Conference, held from February 17 to 19 in Los Angeles.
Kenneth Rosenfield, MD, from Massachusetts General Hospital in Boston, and colleagues compared carotid artery stenting with embolic protection and carotid endarterectomy in asymptomatic patients aged 79 years or younger with severe carotid stenosis who were not at high risk for surgical complications. The researchers found that stenting was noninferior to endarterectomy with respect to the primary composite end point (death, stroke, or myocardial infarction within 30 days, or ipsilateral stroke within one year), with event rates of 3.8 and 3.4%, respectively (P = 0.01 for noninferiority).
Thomas G. Brott, MD, from the Mayo Clinic in Jacksonville, Florida, and colleagues examined the 10-year follow-up results for 2502 patients with carotid artery stenosis who had been randomized to stenting or endarterectomy. The researchers observed no significant difference in the rate of the primary composite end point (stroke, myocardial infarction, or death during the periprocedural period, or any subsequent ipsilateral stroke) between the groups (11.8% for stenting versus 9.9% for endarterectomy; hazard ratio, 1.10; 95% confidence interval, 0.83 to 1.44).
"We did not detect significant between-group differences in either the primary composite end point or the primary long-term end point," Brott and colleagues write.
The Rosenfield study was funded by Abbott Vascular. The Brott study was partially funded by Abbott Vascular Solutions.