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Stents, Endarterectomy Equally Effective at Preventing Stroke

True in long term, but in periprocedural period, risk of stroke higher with carotid-artery stenting

WEDNESDAY, May 26 (HealthDay News) -- Carotid-artery stenting and carotid endarterectomy are equally effective in preventing stroke in the long term, according to a study published online May 26 in the New England Journal of Medicine to coincide with its presentation at the European Stroke Conference, held from May 25 to 28 in Barcelona, Spain.

In the Carotid Revascularization Endarterectomy vs. Stenting Trial, Thomas G. Brott, M.D., of the Mayo Clinic in Jacksonville, Fla., and colleagues randomized 2,502 patients with symptomatic or asymptomatic carotid stenosis to undergo carotid-artery stenting or carotid endarterectomy. The primary composite outcome measure was stroke, myocardial infarction, or death from any cause during the periprocedural period or any ipsilateral stroke within four years after randomization.

The researchers found that four-year rates of the primary end point did not differ significantly in those who underwent carotid-artery stenting and those who underwent carotid endarterectomy (7.2 and 6.8 percent, respectively). During the periprocedural period, the researchers found a higher risk of stroke associated with carotid-artery stenting compared to carotid endarterectomy (4.1 versus 2.3 percent), and a higher risk of myocardial infarction associated with carotid endarterectomy compared to carotid-artery stenting (2.3 versus 1.1 percent) during the periprocedural period.

"Though it appears that the increased risk of stroke with carotid-artery stenting is offset by an increased risk of myocardial infarction with carotid endarterectomy, stroke has greater long-term health consequences than myocardial infarction. The risk-benefit issue is complex and should be discussed with patients," write the authors of an accompanying editorial.

Abbott Vascular Solutions Inc. provided funding and product donations for the study. Several authors disclosed financial ties to Abbott Vascular and/or other medical device and pharmaceutical companies.

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