Stenting versus endarterectomy for treatment of carotid-artery stenosis.
BACKGROUND
Carotid-artery stenting and carotid endarterectomy are both options for treating carotid-artery stenosis, an important cause of stroke.


METHODS
We randomly assigned patients with symptomatic or asymptomatic carotid stenosis to undergo carotid-artery stenting or carotid endarterectomy. The primary composite end point was stroke, myocardial infarction, or death from any cause during the periprocedural period or any ipsilateral stroke within 4 years after randomization.


RESULTS
For 2502 patients over a median follow-up period of 2.5 years, there was no significant difference in the estimated 4-year rates of the primary end point between the stenting group and the endarterectomy group (7.2% and 6.8%, respectively; hazard ratio with stenting, 1.11; 95% confidence interval, 0.81 to 1.51; P=0.51). There was no differential treatment effect with regard to the primary end point according to symptomatic status (P=0.84) or sex (P=0.34). The 4-year rate of stroke or death was 6.4% with stenting and 4.7% with endarterectomy (hazard ratio, 1.50; P=0.03); the rates among symptomatic patients were 8.0% and 6.4% (hazard ratio, 1.37; P=0.14), and the rates among asymptomatic patients were 4.5% and 2.7% (hazard ratio, 1.86; P=0.07), respectively. Periprocedural rates of individual components of the end points differed between the stenting group and the endarterectomy group: for death (0.7% vs. 0.3%, P=0.18), for stroke (4.1% vs. 2.3%, P=0.01), and for myocardial infarction (1.1% vs. 2.3%, P=0.03). After this period, the incidences of ipsilateral stroke with stenting and with endarterectomy were similarly low (2.0% and 2.4%, respectively; P=0.85).


CONCLUSIONS
Among patients with symptomatic or asymptomatic carotid stenosis, the risk of the composite primary outcome of stroke, myocardial infarction, or death did not differ significantly in the group undergoing carotid-artery stenting and the group undergoing carotid endarterectomy. During the periprocedural period, there was a higher risk of stroke with stenting and a higher risk of myocardial infarction with endarterectomy. (ClinicalTrials.gov number, NCT00004732.)
Brott
Thomas G
TG
Mayo Clinic, Griffin 304, 4500 San Pablo Rd., Jacksonville, FL 32224, USA. brott.thomas@mayo.edu
Hobson
Robert W
RW
Howard
George
G
Roubin
Gary S
GS
Clark
Wayne M
WM
Brooks
William
W
Mackey
Ariane
A
Hill
Michael D
MD
Leimgruber
Pierre P
PP
Sheffet
Alice J
AJ
Howard
Virginia J
VJ
Moore
Wesley S
WS
Voeks
Jenifer H
JH
Hopkins
L Nelson
LN
Cutlip
Donald E
DE
Cohen
David J
DJ
Popma
Jeffrey J
JJ
Ferguson
Robert D
RD
Cohen
Stanley N
SN
Blackshear
Joseph L
JL
Silver
Frank L
FL
Mohr
J P
JP
Lal
Brajesh K
BK
Meschia
James F
JF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D011788:Quality of Life; D015607:Stents / Q000009:adverse effects; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control