In symptomatic carotid stenosis, endarterectomy choice if suitable for surgery

January 01, 0001

In symptomatic carotid stenosis, endarterectomy choice if suitable for surgery

The International Carotid Stenting Study researchers compared the safety of carotid artery stenting with that of carotid endarterectomy. The International Carotid Stenting Study (ICSS) is a multicentre, international, randomised controlled trial with blinded adjudication of outcomes. Patients with recently symptomatic carotid artery stenosis were randomly assigned in a 1:1 ratio to receive carotid artery stenting or carotid endarterectomy with stratification by centre with minimisation for sex, age, contralateral occlusion, and side of the randomised artery. Patients and investigators were not masked to treatment assignment. Patients were followed up by independent clinicians not directly involved in delivering the randomised treatment. The trial enrolled 1713 patients (stenting group, n=855; endarterectomy group, n=858).

Between randomisation and 120 days, there were 4.0% events of disabling stroke or death in the stenting group compared with 3.2% events in the endarterectomy group (hazard ratio, HR 1.28). The incidence of stroke, death, or procedural myocardial infarction was 8.5% in the stenting group compared with 5·2% in the endarterectomy group (HR 1.69, significant). Risks of any stroke (HR 1.92) and all-cause death (HR 2.76) were higher in the stenting group than in the endarterectomy group. Three procedural myocardial infarctions were recorded in the stenting group, all of which were fatal, compared with four, all non-fatal, in the endarterectomy group. There was one event of cranial nerve palsy in the stenting group compared with 45 in the endarterectomy group. There were also fewer haematomas of any severity in the stenting group than in the endarterectomy group (31 vs 50 events, significant).

The researchers concluded: "Completion of long-term follow- up is needed to establish the efficacy of carotid artery stenting compared with endarterectomy. In the meantime, carotid endarterectomy should remain the treatment of choice for patients suitable for surgery."

Note that the preference for carotid endarterectomy is for those suitable for surgery.

For the full abstract, click here.

The Lancet published online 26 February 2010 © 2010 Elsevier Limited
Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial. International Carotid Stenting Study investigators.

Category: K. Circulatory, N. Neurological. Keywords: interim analysis of a multicentre international randomised controlled trial, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 26 March 2010

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