MedicalResearch.com Interview with:
Jay S. Giri, MD, MPH
Director, Peripheral Intervention
Assistant Professor of Clinical Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We analyzed data from 6,526 patients in the 5 most recent randomized trials comparing carotid artery stenting to carotid endarterectomy. These procedures are performed to prevent long-term stroke in patients with severe narrowings of their carotid arteries. We learned that the procedures are equally effective in preventing stroke over the long-term. However, the procedures have quite different safety profiles, defined as adverse events that the patients experienced within 30 days of their procedure.
Carotid artery stenting was associated with a higher risk of stroke in the initial 30 days after the procedure. Carotid endarterectomy was associated with greater risks of myocardial infarction (heart attack) and cranial nerve palsy, a variable condition that most often results in difficulty with swallowing or speaking, over this timeframe.
MedicalResearch.com: What should readers take away from your report?
Response: Our results argue that these procedures are not competitive but complementary with equal long-term efficacy but differing safety profiles. If a patient is to undergo one of these treatments for carotid stenosis, the selection of which procedure is chosen should be based on an individualized assessment of their unique risk factors and anatomic characteristics.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: I do not believe there is much value in directly comparing these therapies to one another in additional randomized trials. However, the most important current question in this field remains unanswered.
We do not know what the best management strategy is for patients who have severe carotid stenosis but have had no neurologic symptoms from the narrowing. Perhaps these patients are better served with optimal medical therapies, including good blood pressure/cholesterol control and smoking cessation, rather than either of these 2 procedures.
A current ongoing trial (called CREST 2) is attempting to provide information in this important group of patients, and I believe it is imperative that physicians around the country offer enrollment in this trial to their patients.
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