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Stenting Riskier for Older Patients With Blocked Carotid Artery
Date:9/11/2010

al, the researchers looked for causes of stroke or death.

Those who received stents had a 53 percent higher risk of having a stroke or dying in the four months after the procedure compared with patients who underwent a carotid endarterectomy, the researchers found.

But among those younger than 70, the risk for stroke or death was similar in both procedures. For patients 70 and older, the risk for stroke or death was two times higher in the stent group than for those who underwent endarterectomy (12 percent versus 5.9 percent).

Moreover, in the 30 days following treatment, the risk for stroke or death among the under-70 patients was similar, while 10.5 percent of the 70-and-older group who received stents had a stroke or died, compared with 4.4 percent of the carotid endarterectomy patients, the researchers found.

Dr. Larry B. Goldstein, professor of neurology and director of the Duke Stroke Center at Duke University Medical Center, said another new trial -- CREST -- supports the study results. CREST is the largest trial to date comparing endarterectomy with stenting in patients with a narrowing of the carotid artery, Goldstein said.

"CREST found no difference in the trial's primary outcomes of stroke, death or myocardial infarction [heart attack], but a higher risk of stroke in those having stenting that was balanced by a higher risk of heart attack in those having endarterectomy," he said. The new British study only looked at the rate of stroke and death; findings for heart attack were not part of the methodology.

"Similar to this study, CREST found increased risk of stenting versus endarterectomy in older [patients] as compared to younger patients in whom outcomes seemed better with stenting," Goldstein said.

Many experts had thought that stenting, which is less invasive than endarterectomy, would be safer for older patients, but taken together, this study and CREST suggest that may not be true, he said.

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