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Carotid endarterectomy seen superior to stenting for stroke prevention

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Stroke events are significantly less likely after carotid endarterectomy than after carotid artery stenting, particularly in the long term and among older patients, a Greek team reports.

The findings come from a meta-analysis, reported in Stroke online January 13 by Dr. Konstantinos P. Economopoulos, at the University of Athens, and colleagues. They point out that there have been several meta-analyses comparing outcomes of carotid artery stenting (CAS) versus carotid endarterectomy (CEA), but results of two new trials were recently reported.

The current meta-analysis, the authors explain, “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,” Dr. Economopoulos and colleagues 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. “Taken as a whole, the outcomes of CEA seem superior to CAS,” the investigators conclude, “but there may be subgroups, particularly younger patients, in whom the results seem equivalent.” Reference:
Carotid Artery Stenting Versus Carotid Endarterectomy

Stroke. 2011;42.