Carotid Endarterectomy and Stenting Equally Durable

“Stroke is a devastating injury. This article discusses carotid artery arthrosclerosis. We don’t think of that as often as hardening of the coronary arteries. The carotid arteries are just under the skin in our necks, easy to open, remove the plaque and close again. Stenting has equally good results in this study of 1600 subjects. When you think of stroke, remember to think of your carotid arteries.” Bill Chesnut, MD

 

Carotid Endarterectomy and Stenting Equally Durable, Safe Over Long Term for Preventing Stroke

February 22, 2016

By Alex Morrisson

LOS ANGELES — February 22, 2016 — Carotid endarterectomy and carotid stenting have equal durability and safety in preventing stroke among both symptomatic and asymptomatic patients with greater than a 70% stenosis of their neck arteries, according to results of the landmark Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) presented at the 2016 International Stroke Conference (ISC).

The final 10-year analysis of CREST included 1,607 patients who had been followed up every 6 months for a median of 7.2 years at 117 centres in the United States. Those who underwent carotid stenting procedures experienced 42 ipsilateral strokes (6.9%), compared with patients treated by carotid endarterectomy, who experienced 41 strokes (5.6%), indicating virtually no differences (P = .96) between the methods.

The composite endpoint of stroke, heart attack, or death was virtually the same — about 10% in each group at 10 years, stated lead author Thomas G. Brott, MD, Mayo Clinic, Jacksonville, Florida, speaking at a late-breaker presentation here on February 18. The event curves overlapped for the entire 10-year period, Dr. Brott added.

“The results showed that stenting and surgery were safe, and that patients from both groups had very few strokes during the extended follow-up period,” stated Dr. Brott. “Equal benefit was found for older and younger individuals, men and women, for patients who had previously had a stroke, and for those who had not. The 10-year comparisons of re-narrowing of the carotid artery were very low for both stenting and surgery — about 0.7% per year.”

Approximately 12.2% of the patients who underwent stenting experienced restenosis or the need for revascularisation, compared with 9.6% of the patients who underwent endarterectomy and experienced restenosis or required revascularisation.

Previous interim results from CREST demonstrated that, with an average follow-up of 2.5 years, the overall safety and efficacy of the 2 procedures were largely the same. “Now we have data over a longer period of time that shows the durability of both procedures,” noted Dr. Brott. “With life expectancy increasing in the elderly, these long-term results provide doctors and patients with much-needed information on safety and effectiveness to help guide the choice of treatment options.”

Results were simultaneously published online in the New England Journal of Medicine.