[Stent and surgery for symptomatic carotid stenosis. SPACE study results].
The SPACE trial compared risk and effectiveness of stent-supported angioplasty (CAS) vs carotid endarterectomy (CEA) using a noninferiority design in patients with symptomatic stenoses. Intention-to-treat analysis of the entire study population of 1,214 patients showed that primary endpoint events (ipsilateral stroke or death between randomisation and day 30) occurred in 6.92% of the CAS group and 6.45% of the CEA group. The 95% confidence interval (CI) of the absolute risk difference ranged from -1.94% to +2.87%, therefore the noninferiority was not proven. The same was true for the analysis of protocols. No significant differences between the two treatment methods were found in primary or any of the secondary endpoints. There were also no differences in short-term prevention. The endpoint 'ipsilateral ischemic stroke or vascular death between randomisation and 6 months' occurred in 7.4% of the CAS and 6.5% of the CEA patients (odds ratio 1.16, 95% confidence interval 0.74-1.82). Instent restenoses were significantly more common in the CAS group (4.6% vs 2.2%, odds ratio 2.14, 95% CI 1.10-4.18). Surgery remains the gold standard in treatment of patients with symptomatic carotid artery stenosis. Stent-supported angioplasty can be an alternative only in the hands of an experienced interventionalist with proven low periprocedural complication rate.
Ringleb
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PA
Neurologische Universitätsklinik, Im Neuenheimer Feld 400, 69120, Heidelberg. Peter.Arthur.Ringleb@med.uni-heidelberg.de
Hacke
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D000800:Angioplasty, Balloon; D001317:Austria; D016893:Carotid Stenosis / Q000401:mortality / Q000628:therapy*; D002544:Cerebral Infarction / Q000401:mortality / Q000628:therapy*; D015331:Cohort Studies; D016894:Endarterectomy, Carotid; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D002546:Ischemic Attack, Transient / Q000401:mortality / Q000628:therapy*; D055502:Secondary Prevention; D015607:Stents; D016019:Survival Analysis