Insidermedicine In Depth - February 25, 2010 - Stents

Outcomes of carotid stenting fall short of endarterectomy for the treatment of symptomatic carotid artery stenosis, according to a randomized trial published online ahead of print in The Lancet Neurology.

Here are some recommendations for the use of carotid endarterectomy (CE) From the American Academy of Neurology:

• CE is established as effective for recently symptomatic (within previous 6 months) patients with 70 to 99% internal carotid artery (ICA) angiographic stenosis

• CE should not be considered for symptomatic patients with less than 50% stenosis

• CE may be considered for patients with 50 to 69% symptomatic stenosis, but also consider additional clinical and angiographic variables

Researchers out of the National Hospital for Neurology and Neurosurgery in London representing The International Carotid Stenting Study (ICSS) investigators randomly assigned 1,713 patients with recently symptomatic carotid stenosis to stenting or surgery.

After a follow-up period of up to 120 days, 8.5% of patients in the stent group experienced a stroke, compared with only 5.2% in the surgery group. In total, 84 of the patients in the stent group experienced a stroke or died, compared with only 42 in the surgery group. The main factor driving this difference, however, was a higher rate of non-disabling strokes in the stent group. The incidence of disabling strokes or death was actually similar for both groups. Among 231 patients who underwent magnetic resonance imaging (MRI) after treatment, 50% of those in the stent group and only 17% of those in the surgery group developed new ischemic lesions.

Today's research suggests that endarterectomy should remain the gold standard for the treatment of symptomatic carotid stenosis, at least until stent placement is demonstrated to be as good or better.

Category:

Science & Technology

Tags:

• stent placement
• carotid artery stenosis
• stent vs. endarterectomy
• surgery or stent?

[gfair2]

Do you know if there is ongoing research and development into a minimally-invasive Endarterectomy procedure as opposed to open Carotid surgery?

And can you also comment on the popularity of Endarterectomy for Aortic narrowing?

Thank you.