Carotid stenting yields higher long-term rates of stroke, death vs. endarterectomy

Results of a meta-analysis indicate that carotid artery stenting was associated with a higher risk for stroke and death over the course of follow-up compared with endarterectomy.

However, the researchers found that carotid artery stenting was linked to a lower rate of periprocedural MI vs. endarterectomy.

“Although stenting has more favorable periprocedural outcomes with respect to [MI], the observed increased risk of stroke and death throughout follow-up with stenting suggests that endarterectomy remains the treatment of choice for carotid stenosis,” Kristian B. Filion, PhD, and colleagues wrote.

Filion, from the division of clinical epidemiology at Jewish General Hospital, McGill University, Montreal, and colleagues analyzed data from eight randomized controlled trials with at least 50 patients (n = 7,091) comparing carotid artery stenting vs. endarterectomy for carotid stenosis. Follow-up in those trials ranged from 2 to 10 years.

When the researchers performed a pooled analysis using random-effects models, they found that stenting was linked with increased risk for periprocedural stroke (RR = 1.49; 95% CI, 1.11-2.01; risk difference, 1.7%; 95% CI, 0.3-3) but decreased risk for periprocedural MI (RR = 0.47; 95% CI, 0.29-0.78; risk difference, –0.4%; 95% CI, –0.8 to 0.1) compared with endarterectomy.

Over long-term follow-up, stenting compared with endarterectomy was associated with elevated risk for stroke (RR = 1.36; 95% CI, 1.16-1.61), along with a composite of ipsilateral stroke, periprocedural stroke or periprocedural death (RR = 1.45; 95% CI, 1.2-1.75).

Risk for long-term stroke after stenting was more pronounced in older patients (RR = 1.54; 95% CI, 1.2-1.98) than in younger patients (RR = 1.01; 95% CI, 0.56-1.81), but there were no important differences according to sex or symptomatic status, the researchers reported.

“The higher cumulative incidence in stroke-related events throughout follow-up seems to be driven by an increased risk during the periprocedural period,” Filion and colleagues wrote. “The exclusion of such events suggests that stenting and endarterectomy are comparable in terms of postprocedural stroke rate, but the inclusion of such events is crucial when evaluating the overall safety and efficacy of these interventions.” ? by Erik Swain

Disclosure: One researcher is an employee of Algorithme Pharma. 

Source: www.healio.com