TRIP

Stents, Surgery Both Maintain Open Carotids (CME/CE)

MedPageToday, 2012

-- which enrolled patients with asymptomatic and symptomatic carotid stenosis -- showed that the rate of stroke, MI, or death within the first 30 days was equivalent between the two approaches, although the rate of stroke was higher with stenting and the rate of MI was higher with surgery.
The analysis included 2,191 patients who had a carotid ultrasound reviewed at the core lab for the study.
Through two years of follow-up, hemodynamically significant restenosis -- a 70% blockage or greater -- occurred in 5.8% of the patients in each group.
Only eight patients developed an occlusion -- 0.3% in the stenting group and 0.5% in the endarterectomy group.
Patients who developed a restenosis had about four times the risk of developing an ipsilateral stroke (HR 4.37, P =0.0007), Lal reported.
Overall, 13 patients -- four in the stenting group and nine in the endarterectomy group -- had a stroke.
The number of patients who underwent repeat revascularization also did not differ between the two groups through two years.
Lal noted that findings from CREST and other studies are starting to give clinicians an idea of which patients are best suited for either stenting or endarterectomy.
Patients who have scar tissue in the neck from prior surgery or radiation therapy are better candidates for stenting, whereas patients with carotid arteries that are heavily calcified or extremely tortuous are better off getting surgery, he said.
Philip Gorelick, MD, MPH, medical director of the Hauenstein Neuroscience Center in Grand Rapids, Mich., and an American Heart Association spokesperson, highlighted some other circumstances that might favor one approach over the other.
There is evidence that patients 70 and older , possibly because their arteries are more tortuous, he said.