Carotid stents associated with greater risk of stroke or death than carotid endarterectomy surgery

Oct 11, 2010

For patients with blockages in the carotid artery that supplies blood to the brain, carotid artery stenting (a non-surgical treatment) appears to be associated with an increased risk of both short- and long-term adverse outcomes when compared with surgical treatment (carotid endarterectomy), according to a meta-analysis of previously published studies that was posted online today and will appear in the February 2011 print issue of Archives of Neurology.

"Carotid artery stenting has emerged as an alternative to carotid endarterectomy for the treatment of carotid artery occlusive disease," the authors write as background information in the article. The therapy—which involves threading a catheter through the femoral (groin) artery to the carotid artery, inflating an angioplasty balloon to compress plaque and inserting a stent to keep the artery open—is endorsed by the American Heart Association/American Stroke Association guidelines as a reasonable strategy and recommended by the European Society of Vascular Surgery in certain circumstances. However, its safety and efficacy as compared with carotid endarterectomy (surgery to remove the inner lining of the diseased blood vessel) is controversial.

Sripal Bangalore, M.D., M.H.A., of New York University School of Medicine, New York, and Harvard Clinical Research Institute, Boston, and colleagues conducted a meta-analysis of 13 randomized clinical trials comparing the two treatments conducted through June 2010 and involving 7,477 patients with carotid artery disease. They assessed the risk of death, heart attack (myocardial infarction) and stroke within the periprocedural period (within 30 days of the procedure) as well as intermediate and long-term outcomes.

In the first 30 days, carotid artery stenting was associated with a 65 percent increased risk of death or stroke and a 67 percent increased risk of any stroke. However, the stent procedure was associated with a 55 percent lower risk of heart attack and 85 percent reduction in cranial nerve injury in this timeframe when compared with carotid endarterectomy.

Intermediate- to long-term outcomes were assessed using a composite involving death, any strokes or strokes on the side of the with carotid blockage (ipsalateral stroke) within 30 days or thereafter. Carotid artery stenting as compared with carotid endarterectomy was associated with a 19 percent increase in the risk of such an outcome, as well as an increased risk of various combinations of strokes, ipsilateral and death. Stenting was also associated with an 180-percent increase in the risk of restenosis (repeat narrowing of the carotid artery).

"In this largest and most comprehensive meta-analysis to date using outcomes that are standard in contemporary studies, carotid artery stenting was associated with an increased risk of both periprocedural and intermediate to long-term outcomes, but with a reduction in periprocedural myocardial infarction and cranial nerve injury," the authors conclude. "Strategies are urgently needed to identify patients who are best served by carotid artery stenting vs. carotid endarterectomy."

Explore further: Connecting sleep deficits among young fruit flies to disruption in mating later in life

More information: Arch Neurol. Published online October 11, 2010. doi:10.1001/archneurol.2010.262

add to favorites email to friend print save as pdf

Related Stories

Treatments for blocked carotid arteries vary by US region

Jul 26, 2010

Medicare beneficiaries in some parts of the United States appear more likely to receive carotid endarterectomy, a surgical procedure to clear blockages in the artery supplying blood to the head, whereas those in other regions ...

Recommended for you

Rapid whole-brain imaging with single cell resolution

43 minutes ago

A major challenge of systems biology is understanding how phenomena at the cellular scale correlate with activity at the organism level. A concerted effort has been made especially in the brain, as scientists are aiming to ...

Conceptual representation in the brain: Towards mind-reading

5 hours ago

Your measured brain signals can reveal whether you are thinking about an animal or a tool. That's what neuroscientist Irina Simanova discovered during her PhD at Radboud University, where she investigated the conceptual representation ...

User comments : 0

More news stories

Turning off depression in the brain

Scientists have traced vulnerability to depression-like behaviors in mice to out-of-balance electrical activity inside neurons of the brain's reward circuit and experimentally reversed it – but there's ...

Spate of Mideast virus infections raises concerns

A recent spate of infections from a frequently deadly Middle East virus is raising new worries about efforts to contain the illness, with infectious disease experts urging greater vigilance in combatting ...

Clean air: Fewer sources for self-cleaning

Up to now, HONO, also known as nitrous acid, was considered one of the most important sources of hydroxyl radicals (OH), which are regarded as the detergent of the atmosphere, allowing the air to clean itself. ...

Thinnest feasible nano-membrane produced

A new nano-membrane made out of the 'super material' graphene is extremely light and breathable. Not only can this open the door to a new generation of functional waterproof clothing, but also to ultra-rapid filtration. The ...

There's something ancient in the icebox

Glaciers are commonly thought to work like a belt sander. As they move over the land they scrape off everything—vegetation, soil, and even the top layer of bedrock. So scientists were greatly surprised ...