ASA: Carotid Stenting May Be Effective in Preventing Stroke

But two other studies say it has worse outcomes than endarterectomy in carotid stenosis patients

08 mar 2010-- Carotid stenting and carotid endarterectomy have similar long-term outcomes for preventing stroke in patients with carotid stenosis, according to a study presented at the American Stroke Association's 2010 International Stroke Conference, held from Feb. 23 to 26 in San Antonio. However, two studies published online Feb. 26 in The Lancet and The Lancet Neurology found that carotid stenting is associated with worse outcomes than carotid endarterectomy in patients with carotid artery stenosis in the months after the procedure and is associated with ischemic brain lesions shortly after treatment.

In the study presented at the International Stroke Conference, Thomas G. Brott, M.D., from the Mayo Clinic in Jacksonville, Fla., and colleagues randomly assigned symptomatic patients and symptomatic patients with carotid stenosis to carotid stenting or carotid endarterectomy. After a mean follow-up of 2.5 years, the researchers found that outcomes were similar in both groups in terms of stroke, heart attack, and death. However, in the weeks after the procedure, the risk of stroke was higher in the stenting group, while the risk of myocardial infarction was lower.

In The Lancet study, Martin M. Brown, M.D., of University College London, and colleagues randomly assigned patients with carotid artery stenosis to carotid artery stenting or carotid endarterectomy. After 120 days, the stenting group had a higher risk of disabling stroke or death; stroke, death, or procedural myocardial infarction; any stroke; and death from any cause. In The Lancet Neurology study, Leo H. Bonati, M.D., from University Hospital Basel in Switzerland, and colleagues performed magnetic resonance imaging on a subset of patients who participated in the trial from The Lancet. Using diffusion-weighted imaging, the researchers found that patients in the stenting group were more likely to have at least one new ischemic brain lesion after treatment.

"The widespread use of carotid stenting, especially its routine use as first-choice treatment for symptomatic carotid stenosis, does not seem to be justified for the time being," writes the author of an accompanying editorial in The Lancet Neurology, adding that "an objective outcome surrogate parameter, such as the occurrence of ischemic lesions in serial diffusion-weighted imaging, seems a promising research tool."

Both Lancet studies were partially funded by Sanofi-Synthélabo, and two authors reported financial or consulting relationships with medical device companies. The conference study was partially funded by Abbott Laboratories.

Abstract - Brown
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Abstract - Bonati
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Abstract 197
International Stroke Conference 2010