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

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, one of the JAMA/Archives journals.

"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 therapywhich 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 openis 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 brain 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 stroke 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."

(Arch Neurol. Published online October 11, 2010. doi:10.1001/archneurol.2010.262. Available pre-embargo to the media at

Editor's Note: Senior author Dr. Bhatt has received research grants form AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Heartscape, Sanofi Aventis and The Medicines Company. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Editorial: Meta-Analysis and Other Data Should Guide Personalized Medical Decisions for Each Patient

"What message can doctors take home from the past surgery vs. stenting horse races, from the numerous reports of results in patients not entered in trials, from the meta-analysis in this month's Archives and from the recently published results of the Carotid Revascularization Endarterectomy vs. Stenting Trial?" write Louis R. Caplan, M.D, of Beth Israel Deaconess Medical Center, Boston, and Thomas G. Brott, M.D., of Mayo Clinic, Jacksonville, Fla., in an accompanying editorial.

"Both therapeutic procedures are effective. Both procedures showed a relatively low rate of serious complications. Surgery is superior concerning some outcomes; stenting seems to have advantages in others," they write. In addition, "aggressive medical treatment of blood lipids, blood pressure and anti-platelets along with lifestyle changes may be as good as or better than either surgery or stenting at stroke and myocardial infarcts prevention."

"The past decades have produced three very effective treatmentsmedical, surgical and interventionalfor individuals with carotid artery disease," they conclude. "The results and complications of each can be improved. We have learned much from the trials and they are a beacon to engender even further improvements. However, care of individual patients will always rest in the hands of a trained experienced doctor on one end of a stethoscope and a patient on the other end. Trials can enlighten that encounter but never replace it."

(Arch Neurol. Published online October 11, 2010. doi:10.1001/archneurol.2010.268. Available pre-embargo to the media at

Editor's Note: Please see the article for additional information, including author contributions and affiliations, financial disclosures, funding and support, etc.


Contact: Diane Keefe
JAMA and Archives Journals

Related medicine news :

1. Stenting Riskier for Older Patients With Blocked Carotid Artery
2. Surgery or stenting for carotid artery disease? Question remains
3. Carotid artery ultrasound is an effective alternative to more invasive coronary angiography
4. UB Neurosurgery Awarded Full Accreditation For Doppler Testing Of Carotid Artery Disease
5. EPIC study finds new embolic protection device had 97.5 percent success rate during carotid artery stenting
6. Stents as good as surgery for clogged carotid arteries
7. In Test of Stents, Old Standby Wins Out
8. Results of the placement of multiple endoscopic stents for postoperative biliary strictures remains excellent after long-term follow-up
9. MRI could be used for routine surveillance of great vessel stents
10. Drug-eluting stents confirmed safe, effective for long-term use
11. Many Dont Take Blood Thinner After Getting Stents
Post Your Comments:
(Date:6/27/2016)... Lafayette, California (PRWEB) , ... ... ... a pioneer in the patient payment industry today announced its strategic partnership ... and health system workflows. , The two companies’ proven, proprietary technology combine ...
(Date:6/26/2016)... ... ... Pixel Film Studios Released ProSlice Levels, a Media Slicing Effect Plugin ... whole new perspective by using the title layers in ProSlice Levels to split-up ... Levels contains over 30 Different presets to choose from. FCPX users can ...
(Date:6/25/2016)... ... June 25, 2016 , ... Austin residents seeking Mohs surgery ... of Mohs Surgery and to Dr. Russell Peckham for medical and surgical dermatology. , ... for skin cancer. The selective fellowship in Mohs Micrographic Surgery completed by Dr. Dorsey ...
(Date:6/25/2016)... ... June 25, 2016 , ... ... recover from injury. Recently, he has implemented orthobiologic procedures as a method for ... is one of the first doctors to perform the treatment. Orthobiologics are substances ...
(Date:6/24/2016)... , ... June 24, 2016 , ... June 19, 2016 ... dangers associated with chronic pain and the benefits of holistic treatments, Serenity Recovery ... are suffering with Sickle Cell Disease. , Sickle Cell Disease (SCD) is a disorder ...
Breaking Medicine News(10 mins):
(Date:6/23/2016)... June 23, 2016 Capricor ... ), a biotechnology company focused on the discovery, ... that patient enrollment in its ongoing randomized HOPE-Duchenne ... exceeded 50% of its 24-patient target. Capricor expects ... third quarter of 2016, and to report top ...
(Date:6/23/2016)... PARK RIDGE, Ill. and INDIANAPOLIS ... caliber of students receiving a Lilly Diabetes Tomorrow,s Leaders ... hands. The 2016 scholarship winners, announced today online at ... refused to let type 1 diabetes stand in the ... Lilly Diabetes has supported the Foundation,s scholarship program since ...
(Date:6/23/2016)... , June 23, 2016 The vast majority ... outpatient dialysis facility.  Treatments are usually 3 times a ... per visit, including travel time, equipment preparation and wait ... but especially grueling for patients who are elderly and ... skilled nursing and rehabilitation centers for some duration of ...
Breaking Medicine Technology: