Carotid endarterectomy superior to stenting for stroke prevention
Last Updated: 2011-01-26 11:25:22 -0400 (Reuters Health)
By Robert Saunders
NEW YORK (Reuters Health) - Stroke events are significantly less likely after endarterectomy than after stenting for carotid artery stenosis, particularly in older patients, a Greek team reports.
"Surgical treatment of carotid artery stenosis should change," Dr. Konstantinos Economopoulos stated an email to Reuters Health. "Carotid artery stenting should be administered only within the context of a clinical trial."
His conclusions are based on the results of a meta-analysis, reported in Stroke online January 13.
Dr. Economopoulos, at the University of Athens, and his colleagues note there have been several meta-analyses comparing outcomes of carotid artery stenting (CAS) versus carotid endarterectomy (CEA), but results of two new trials recently became available. "The present meta-analysis may improve the current understanding of the fine balance describing the CEA vs. CAS comparison," Dr. Economopoulos commented.
The analysis "aims to provide a comprehensive approach to short-term and long-term comparison between CEA and CAS synthesizing all available data coming from published randomized studies." It covers 13 randomized trials involving 3723 patients who underwent CEA and 3754 who had CAS.
The results show that in the short term, compared to CEA, CAS is associated with elevated risk for stroke (pooled OR, 1.53) and "death or stroke" (pooled OR, 1.54), but with lower risk of myocardial infarction (pooled OR, 0.48) and cranial nerve injury (pooled OR, 0.09).
Regarding long-term outcomes, CAS was again associated with higher rates of stroke (pooled OR, 1.37) and "death or stroke" (pooled OR, 1.25). "The difference in long-term stroke rates was particularly sizeable in patients >68 years, but little difference in rates was observed in those <68 years," the investigators found.
They say the results indicate that CEA lowers stroke risk more than CAS in both the short and long term, and confirm that CEA is associated with increased risk for periprocedural cranial nerve injury and MI. "In addition, the present analysis lends support to the recent mounting evidence indicating that CAS is associated with a substantially higher risk of short-term and long-term stroke in patients aged over 70 years compared to CEA," Dr. Economopoulos noted.
"Taken as a whole, the outcomes of CEA seem superior to CAS," the authors conclude, "but there may be subgroups, particularly younger patients, in whom the results seem equivalent."
SOURCE:http://bit.ly/eNm5Du
Stroke 2011.
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