Carotid artery stenting and carotid endarterectomy equally safe and effective for people at risk for stroke

Carotid artery stenting, a less invasive alternative to surgery on the carotid artery (carotid endarterectomy), is equally safe and effective for people at risk for stroke as carotid endarterectomy, according to a major new study presented today at the 2010 International Stroke Conference in San Antonio, Texas. The study findings indicate both carotid stenting and carotid endarterectomy are continually improving and have become "extraordinarily safe" for the treatment of carotid artery disease, according to investigators in the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST), one of the largest and most rigorous randomized stroke prevention trials ever undertaken.

The overall safety and efficacy of the two procedures, based on the combined primary endpoint of stroke, heart attack and death, was largely the same with equal benefits for both men and for women, and for patients who had previously had a stroke and for those who had not. There were also some notable differences. Investigators found:

• The age of the patient made a difference – younger patients did better with stents, older patients did better with surgery. For patients 69 years and younger, stenting results were superior to surgical results; the younger the patient, the larger the stenting benefit. Conversely, for patients older than 70, surgical results were slightly better than stenting; the older the patient, the larger the surgery benefit. 
• There were twice as many heart attacks in the surgical group, 2.3 percent compared to 1.1 percent in the stenting group.
• The incidence of overall stroke was 4.1 percent in the stent group vs. 2.3 percent in the surgical group. Importantly, however, there was no difference for major, disabling strokes between the two groups. The difference in stroke was that of a slight increase in minor, non-disabling strokes – the type of stroke whose symptoms largely resolve within several weeks. 

REMARKS FROM SCAI LEADERS

"The implications of CREST for patients at risk for stroke are significant," said Christopher White, M.D., FSCAI, chairman, department of cardiology, and director of the Ochsner Heart & Vascular Institute, Ochsner Medical Center in New Orleans, and secretary of the Society for Cardiovascular Angiography and Interventions. "Previously, carotid stenting has typically been accepted as an alternative for patients who are not good candidates for surgery. As a result of these new findings, physicians will now have more safe and effective options in tailoring treatments for all of their patients at risk for stroke. We encourage the Centers for Medicare and Medicaid (CMS) to reopen its coverage decision on carotid stenting so more patients may benefit from a less-invasive option."

"The CREST data suggest that a larger group of patients, especially younger patients, are good candidates for carotid stenting," said Kenneth Rosenfield, M.D., FSCAI, an interventional cardiologist and section head for vascular medicine and intervention at Massachusetts General Hospital. "These results will enable patients to have more choices, including less-invasive therapy, for clearing their carotid artery. Physicians will also be able to provide better guidance to their patients as to benefits and risks for the various alternative treatments, based on an individual's health history; this should lead to improved patient outcomes."

"As stroke is the third leading cause of death in the United States, the CREST data are valuable – and reassuring – news for patients," said SCAI President Steven R. Bailey, M.D., FSCAI, president of Society for Cardiovascular Angiography and Interventions, and chief, division of cardiology, Janey Briscoe Distinguished Chair of Cardiovascular Research and professor of medicine and radiology at the University of Texas Health Sciences Center at San Antonio, Texas. "Patients at average risk for stroke now have two equally prudent treatment options to consider with their physicians."

SOURCE Society for Cardiovascular Angiography and Interventions (SCAI)