09/04/2010 - News

Which Treatment is Better for Carotid Artery Stenosis?

By: June Chen, MD

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Atherosclerosis, or plaque build-up, in the carotid artery is an important cause of stroke. Carotid endarterectomy and carotid artery stenting are both options for treatment of carotid artery stenosis, narrowing of the carotid artery due to atherosclerosis. But, which is better? According to a new study published online in the New England Journal of Medicine, carotid endarterectomy and carotid artery stenting are associated with similar rates of stroke, heart attack, or death.

Investigators from the CREST study randomly assigned 2,502 patients with symptomatic or asymptomatic carotid artery stenosis to either carotid endarterectomy or carotid artery stenting. After an average follow-up period of 2.5 years, the investigators found no significant difference in the estimated 4-year rates of stroke, heart attack, or death from any cause between the two groups. They did, however, find that patients who underwent carotid artery stenting had a higher risk of stroke in the period immediately following stent placement. They also found that patients who underwent carotid endarterectomy had a higher risk of heart attack in the time period following the surgical procedure. In addition, younger patients seemed to have fewer complications after carotid artery stentingand older patients had fewer events after carotid endarterectomy.
 
The authors of the study conclude that carotid revascularization, through either carotid endarterectomy or carotid artery stenting, is effective and safe when performed by highly-qualified surgeons and interventionists. Further advancements in training, technique, stent design, and medications may lead to further improvements in the effectiveness of these interventions.

Source: NEJM. Published online 26 May 2010.

Created on: 06/01/2010
Reviewed on: 09/04/2010

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