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Endarterectomy Safer Than Stenting for Carotid Stenosis

Study discontinued because of poorer short-term outcome after stenting

WEDNESDAY, Oct. 18 (HealthDay News) -- In patients with 60 percent or greater carotid artery stenosis, endarterectomy has better survival and a lower incidence of stroke in the short term than stenting, according to the results of a randomized trial published in the Oct. 19 issue of the New England Journal of Medicine. The study was halted early due to the clear superiority of endarterectomy.

In the study, Jean-Louis Mas, M.D., of the Universite Rene Descartes in Paris, France, and the Endarterectomy versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S) trial investigators randomized patients to either endarterectomy or stenting. The primary endpoint was stroke or death within 30 days of treatment.

The study was terminated after 527 patients were enrolled because of safety reasons -- the incidence of any stroke or death after endarterectomy was 3.9 percent but 9.6 percent after stenting. Disabling stroke or death was also higher after stenting compared with endarterectomy and the differences were still apparent six months after the procedures.

"Although the EVA-3S trial raises concerns about the safety of carotid stenting and bolsters the call for standardized training and credentialing requirements, it cannot be considered the final word on carotid stenting for patients with an average surgical risk," according to Anthony Furlan, M.D., of the Cleveland Clinic. Stenting should still be considered for symptomatic patients with greater than 70 percent stenosis and with high surgical risk, he points out in an accompanying editorial.

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