Who Should Have A Carotid Artery Stent vs Endarterectomy?

MedicalResearch.com Interview with:
Sophie Vincent, Medical Student
McGill University and
Kristian Filion, PhD FAHA
Assistant Professor of Medicine
Division of Clinical Epidemiology
Jewish General Hospital/McGill University

Medical Research: What is the background for this study? What are the main findings?

Response: Patients with carotid atherosclerosis causing vascular stenosis are at increased risk of stroke, which is the third leading cause of death in the United States and in Canada. Carotid artery stenting and carotid endarterectomy are the primary surgical options for the treatment of carotid stenosis. With the assumption that an endovascular approach would offer a more favorable safety profile than open surgical procedure, the use of stenting increased significantly following its entry into the market in the 1990s. However, despite this observed increase in use, the long-term safety and efficacy of stenting relative to endarterectomy remained unclear, which is why we decided to conduct this study.

Although carotid artery stenting has more favorable periprocedural outcomes with respect to myocardial infarction, hematoma, and cranial nerve palsy, the observed increased risk of stroke throughout follow-up with stenting suggests that endarterectomy remains the treatment of choice for the management of carotid stenosis.

Medical Research: What should clinicians and patients take away from your report?

Response: Current guidelines recommend the use of endarterectomy as treatment for patients with severe symptomatic and asymptomatic carotid stenosis. For symptomatic patients at elevated surgical risk, stenting is an available treatment option.  However, clinicians and patients should consider that stenting is associated with an increased risk of long-term stroke outcomes compared with carotid endarterectomy when considering the potential benefits and harms of each treatment option.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: While the available data provide strong evidence regarding an increased risk of stroke with stenting, much of this evidence is derived from symptomatic patients. Although we did not identify differences in treatment effects between symptomatic and asymptomatic patients in our subgroup analyses, such analyses are underpowered, and more research is needed to evaluate the potential use of stenting in asymptomatic patients. Furthermore, most of the trials comparing these procedures to medical therapy were conducted many years ago, and there remains a need for additional studies comparing surgical interventions to current medical management.

Citation:

Meta-Analysis of Randomized Controlled Trials Comparing the Long-Term Outcomes of Carotid Artery Stenting Versus Endarterectomy

Sophie Vincent, Maria Eberg, Mark J. Eisenberg, and Kristian B. Filion

Circ Cardiovasc Qual Outcomes. 2015;8:S99S108,doi:10.1161/CIRCOUTCOMES.115.001933

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Sophie Vincent and Kristian Filion, PhD (2015). Who Should Have A Carotid Artery Stent vs Endarterectomy? MedicalResearch.com

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