AoN: Carotid stenting increases restenosis by 180% vs. endarterectomy

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Researchers found that carotid artery stenting (CAS) increased the risk of short-term and long-term adverse outcomes by 19 percent when compared to carotid endarterectomy (CEA), and found that while CAS may reduce the risk of MI, it also increases the rates of restenosis by 180 percent, according to the results of a meta-analysis published online in the Archives of Neurology.

Despite mounting evidence that suggests CAS may be an alternative to the surgical CEA approach to repairing stenoses carotid arteries, Sripal Bangalore, MD, MHA, of the New York University School of Medicine in New York City, and colleagues evaluated the perioprocedural and intermediate to long-term benefits and harms of CAS compared to CEA, and found that CAS was associated with an increased risk of stroke.

The researchers conducted a meta-analysis of 13 previous clinical trials that compared CAS to CEA. The 13 trials evaluated 7,477 patients with CAD and randomized them to receive either CAS or CEA.

The researches assessed the risk of death, MI and stroke at 30-days after procedure and also evaluated the intermediate and long-term outcomes.

The results showed that within the first 30 days, CAS was reportedly associated with a 65 percent increased risk of death or stroke and a 67 percent increased risk of any stroke. Additionally, the researchers found that CAS was associated with a 55 percent decreased risk of MI and an 85 percent reduction in cranial nerve injury compared to CEA.

The researchers also assessed intermediate and long-term outcomes of death, stroke or ipsilateral stroke at 30 days, and after. They found that CAS had a 19 percent increased risk of the composite outcomes when compared to CEA.

The authors also reported that CAS decreased the risk of cranial nerve injury by 85 percent; however, CAS increased the risk of intermediate to long-term carotid restenosis by 180 percent.

Meanwhile, CAS was associated with a 15 percent reduction in MI, but was linked to a 19 percent, 38 percent, 24 percent and 48 percent increase in intermediate to long-term outcomes of periprocedural death or stroke and ipsilateral stroke thereafter, death or any stroke and any stroke, respectively.

"Our meta-analysis raises a number of important issues," the authors wrote. “Strategies are urgently needed to identify patients who are best served by carotid artery stenting versus carotid endarterectomy,” the authors wrote.

Additionally, Bangalore and colleagues said that there is a need for the development of risk scores that would better select patients with a low risk of periprocedural complications following CAS.

"Although randomized trials account for observed differences in baseline variables, unmeasured confounders may be missed. The question of the effect of relatively inexperienced operators performing stenting versus well-experienced surgeons performing CEA has not been resolved," the authors wrote.

The authors said that future studies that assess operator experience and patient selection should be conducted.