"You can't answer that question on the basis of our study," Cutlip said. "What we can say is that the results are similar in high-risk patients at one-year and now at three-year outcomes."
The real answer probably will come from an ongoing major government-funded study of several thousand low- and moderate-risk participants, Gurm and Cutlip said. Results from that effort are expected in "two to three years," Gurm said.
"Also, there are several registries from randomized studies that are going on," Cutlip said. "Their results might sway opinion."
In the meantime, most people who have a carotid artery procedure at a community hospital rather than a specialized center will continue to have surgery, agreed Dr. Deepak Bhatt, associate director of the Cleveland Clinic's Cardiovascular Coordinating Center.
At least one study has shown that carotid stenting can be done as effectively by community physicians as by specialists. And it is possible for someone who needs a procedure and would prefer stenting to have it done in the name of research, by enrolling in a trial comparing the two procedures, Bhatt said.
"If you don't really want surgery you can have a stent, but under the umbrella of research, where you are followed closely," he said.
The various carotid artery procedures are described by the Cleveland Clinic.
SOURCES: Hitinder S. Gurm, M.D., assistant professor, medicine, University of Michigan, Ann Arbor; Donald E. Cutlip, M.D., associate professor, medicine, Harvard Medical School; Deepak Bhatt, M.D., associate director, Cleveland Clinic Cardiovascular Coordinating Center; April 10, 2008, New England Journal of Medicine
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