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Carotid stents associated with greater risk of stroke or death than carotid endarterectomy surgery
Date:10/11/2010

ociated 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 www.jamamedia.org.)

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 rep
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Contact: Diane Keefe
diane.keefe@va.gov
857-203-5879
JAMA and Archives Journals
Source:Eurekalert

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