Journal Article10.1056/NEJMOA061752
Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis
Jean-Louis Mas,Gilles Chatellier,Bernard Beyssen,Alain Branchereau,Thierry Moulin,Jean-Pierre Becquemin,Vincent Larrue,Michel Lievre,Didier Leys,Jean-François Bonneville,Jacques Watelet,Jean-Pierre Pruvo,Jean-François Albucher,Alain Viguier,Philippe Piquet,Pierre Garnier,Fausto Viader,Emmanuel Touzé,Maurice Giroud,Hassan Hosseini,Jean-Christophe Pillet,Pascal Favrole,Jean-Philippe Neau,Xavier Ducrocq,S Investigators,Abstr Act +25 more
TL;DR: In this study of patients with symptomatic carotid stenosis of 60% or more, the rates of death and stroke at 1 and 6 months were lower with endarterectomy than with stenting.
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Abstract: BACKGROUND: Carotid stenting is less invasive than endarterectomy, but it is unclear whether it is as safe in patients with symptomatic carotid-artery stenosis. METHODS: We conducted a multicenter, randomized, noninferiority trial to compare stenting with endarterectomy in patients with a symptomatic carotid stenosis of at least 60%. The primary end point was the incidence of any stroke or death within 30 days after treatment. RESULTS: The trial was stopped prematurely after the inclusion of 527 patients for reasons of both safety and futility. The 30-day incidence of any stroke or death was 3.9% after endarterectomy (95% confidence interval [CI], 2.0 to 7.2) and 9.6% after stenting (95% CI, 6.4 to 14.0); the relative risk of any stroke or death after stenting as compared with endarterectomy was 2.5 (95% CI, 1.2 to 5.1). The 30-day incidence of disabling stroke or death was 1.5% after endarterectomy (95% CI, 0.5 to 4.2) and 3.4% after stenting (95% CI, 1.7 to 6.7); the relative risk was 2.2 (95% CI, 0.7 to 7.2). At 6 months, the incidence of any stroke or death was 6.1% after endarterectomy and 11.7% after stenting (P=0.02). There were more major local complications after stenting and more systemic complications (mainly pulmonary) after endarterectomy, but the differences were not significant. Cranial-nerve injury was more common after endarterectomy than after stenting. CONCLUSIONS: In this study of patients with symptomatic carotid stenosis of 60% or more, the rates of death and stroke at 1 and 6 months were lower with endarterectomy than with stenting. (ClinicalTrials.gov number, NCT00190398 [ClinicalTrials.gov].).
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TL;DR: Although technological advances, cerebral protection devices, perioperative pharmacological management, and increasing experience are all clinically significant factors influencing the short-term results, none appeared to be statistically significant in this patient sample.
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Protected Carotid-Artery Stenting versus Endarterectomy in High-Risk Patients
Jay S. Yadav,Mark H. Wholey,Richard E. Kuntz,Pierre B. Fayad,Barry T. Katzen,Gregory J. Mishkel,Tanvir Bajwa,Patrick L. Whitlow,Neil E. Strickman,Michael R. Jaff,Jeffrey J. Popma,David Snead,Donald E. Cutlip,Brian G. Firth,Kenneth Ouriel +14 more
TL;DR: Stenting with the use of an emboli-protection device is a less invasive revascularization strategy than endarterectomy in carotid-artery disease and among patients with severe carotidsartery stenosis and coexisting conditions, it is found that the less invasive strategy, stenting, was not inferior to endarteretomy.
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