Updated October 30, 2014.
A setback was delivered last week to doctors who want to extend the use of stents beyond the treatment of coronary artery disease.
A favorite therapeutic target for proponents of stents has been the treatment of blockages in the carotid artery - the large artery in the neck that supplies blood to the brain. Blockages in the carotid artery (called carotid artery stenosis) can lead to strokes and transient ischemic attacks (TIAs - so-called "mini" strokes, in which the neurological deficit resolves within 24 hours).
Traditionally, vascular surgeons treat carotid stenosis by a surgical procedure called carotid endarterectomy - where they surgically "ream out" the blocked artery. In recent years, however, other physicians have advocated the much less invasive approach of stenting the blocked carotid artery, the same way blocked coronary arteries have been stented. Stenting, it has been assumed, should be safer than the traditional approach.
But last week at the European Stroke Conference in Stockholm, investigators from London reported on safety results from the International Carotid Stenting Study. In this study, over 1700 patients with carotid stenosis were randomized to either surgery or stenting. While the long-term results from the trial will not be available until 2011, the 30-day post-procedure results (reflecting the relative safety of the two procedures) were reported last week. These results showed a significantly higher incidence of early stroke (within 30 days of the procedure) with stenting as opposed to surgery.
In fact, strokes occurred after stenting nearly twice as often as after surgery.
These results are consistent with results from two earlier trials comparing surgery with stenting for carotid stenosis. Neither one showed a more favorable safety profile with stenting, and one of them, like the current study, suggested stenting was less safe.
While it is still possible that the long-term results may show that stenting ultimately is superior to surgery, even that result would require a patient to accept increased early risk for a reduced long-term risk. In any case, for now, surgical carotid endarterectomy, and not stenting, should remain the standard surgical approach to treating carotid stenosis.
A setback was delivered last week to doctors who want to extend the use of stents beyond the treatment of coronary artery disease.
A favorite therapeutic target for proponents of stents has been the treatment of blockages in the carotid artery - the large artery in the neck that supplies blood to the brain. Blockages in the carotid artery (called carotid artery stenosis) can lead to strokes and transient ischemic attacks (TIAs - so-called "mini" strokes, in which the neurological deficit resolves within 24 hours).
Traditionally, vascular surgeons treat carotid stenosis by a surgical procedure called carotid endarterectomy - where they surgically "ream out" the blocked artery. In recent years, however, other physicians have advocated the much less invasive approach of stenting the blocked carotid artery, the same way blocked coronary arteries have been stented. Stenting, it has been assumed, should be safer than the traditional approach.
But last week at the European Stroke Conference in Stockholm, investigators from London reported on safety results from the International Carotid Stenting Study. In this study, over 1700 patients with carotid stenosis were randomized to either surgery or stenting. While the long-term results from the trial will not be available until 2011, the 30-day post-procedure results (reflecting the relative safety of the two procedures) were reported last week. These results showed a significantly higher incidence of early stroke (within 30 days of the procedure) with stenting as opposed to surgery.
In fact, strokes occurred after stenting nearly twice as often as after surgery.
These results are consistent with results from two earlier trials comparing surgery with stenting for carotid stenosis. Neither one showed a more favorable safety profile with stenting, and one of them, like the current study, suggested stenting was less safe.
While it is still possible that the long-term results may show that stenting ultimately is superior to surgery, even that result would require a patient to accept increased early risk for a reduced long-term risk. In any case, for now, surgical carotid endarterectomy, and not stenting, should remain the standard surgical approach to treating carotid stenosis.