Endarterectomy or Carotid Artery Stenting? A Question That Still Generates Studies

There have been several studies offering contradictory data on the relative effectiveness of carotid artery stenting and carotid artery endarterectomy for the prevention of stroke due to carotid artery stenosis.

The authors of this study performed a meta-analysis assessing the efficacy of these techniques, given recently published clinical trial data.

They selected randomized trials with at least 50 patients published as of April 30^th, 2016, in order to compare both alternatives. Stenting had to include the use of distal-protection devices.

The study analyzed 6526 patients from 5 randomized trials with a mean follow-up of 5.3 years. The composite endpoint of peri-procedural death, infarction or stroke, plus non-peri-procedural ipsilateral stroke was similar between techniques (odds ratio [OR]: 1.22; 95% confidence interval [CI]: 0.94 to 1.59).

The risk of any peri-procedural stroke plus non-peri-procedural ipsilateral stroke was higher for patients who underwent stenting (OR: 1.50; 95% CI: 1.22 to 1.84). This higher risk of stroke was mostly attributed to peri-procedural minor stroke (OR: 2.43; 95% CI: 1.71 to 3.46).

Stenting was also associated with significantly lower risk of peri-procedural infarction (OR: 0.45; 95% CI: 0.27 to 0.75) and cranial nerve palsy.

Conclusion

Both carotid artery stenting and endarterectomy were associated with similar rates of a composite endpoint of peri-procedural death, infarction or stroke, plus non-peri-procedural ipsilateral stroke. The risk of long-term overall stroke was higher with stenting, mostly due to peri-procedural minor stroke, and lower rates of infarction and cranial nerve palsy than surgery.

Original title: Carotid Artery Stenting Versus Endarterectomy for Stroke Prevention. A Meta-Analysis of Clinical Trials.

Reference: Partha Sardar et al. J Am Coll Cardiol 2017;69:2266-75.

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.