BENEFITS, RISKS OF CAROTID STENTING REMAIN UNCLEAR DESPITE STUDIES
Although a recent study shows patients implanted with stents to treat clogged carotid arteries could be at greater risk for stroke or death than those treated with surgery, inconsistent results from a number of other clinical trials mean the jury is still out on the real benefits and risks of stenting.
Researchers do not have a full understanding of stent risk versus surgery risk due to discrepancies in the numbers of patients enrolled, types of stents used and level of physician experience required in the various studies, according to an editorial in the New England Journal of Medicine (NEJM).
At issue is how best to treat symptomatic carotid stenosis, a degenerative condition in which the inner wall of the carotid artery -- a major vein located in the front of the neck that carries blood from the heart to the brain -- becomes clogged with atherosclerotic plaque consisting of dead cells, fatty compounds and cholesterol crystals.
Results from a French study, "Endarterectomy versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis" (EVA-3S), were published in the Oct. 19 issue of NEJM.
The EVA-3S researchers found a nearly threefold increase, 3.9 to 9.6 percent, in the incidence of stroke or death within 30 days after minimally invasive stenting compared with the rate after endarterectomy -- the surgical removal of plaque from the arterial walls.