If an individual is at risk of stroke, doctors will most likely recommend two procedures: stenting or carotid endarterectomy. Such interventions can get very invasive; therefore, it is important to choose which one can provide the best outcomes with the littlest risk.
So, which is which?
Either, a new study has found.
Experts were able to discover that stenting or carotid endarterectomy are equally safe and effective and that the resulting effects of both do not have significant differences, at least up to a period of five years.
Two Procedures In The Limelight
Carotid-artery stenting involves placing a flexible mesh tube into the blocked part of the artery. This is performed by using a long catheter that delivers the mesh to the artery and is inflated to expand the narrowed pathways and improve blood flow. The blockage will be pressed against the vessel wall and an umbrella-like filter is also used to catch plaque debris.
Carotid endarterectomy is a surgical procedure that entails removing the inner lining of the artery if it has already thickened from plaque. This procedure has been the standard among patients who cannot tolerate open surgery.
In a 2010 study called Carotid Revascularization Endarterectomy versus Stenting Trial (CREST), researchers found that both had similar effects. The only difference is that the risk of minor stroke immediately after the operation is a little higher in stenting.
While the results are valuable, the said test examined patients with or without signs and symptoms of stroke. The current study, called Asymptomatic Carotid Trial (ACT) I, delved specifically on individuals who have no clinical manifestations of stroke.
Verdict Of Latest Study: Deuce
ACT I involved 1,453 individuals aged 79 and below. All of them had not experienced stroke-related symptoms, but has a 70-99 percent of narrowing in one carotid artery.
The study subjects were randomly assigned to undergo either stenting (1,089 patients) or carotid endarterectomy (364 patients). Researchers performed follow-ups one, six and 12 months later, then once per year up to five years.
The findings of the study show that there was no significant difference in the risk of stroke or death 30 days after the operation. Both had a low risk of about 3.5 percent each.
The long-term outcomes have no distinct characteristics as well. Stenting and carotid endarterectomy caused 97.3 percent and 97.8 percent of the participants to remain stroke-free in the treated artery.
"We did not find significant differences in long-term outcomes between the study groups in this large randomized trial," the authors write.
The CREST trial will have a second version dubbed CREST 2. This time, experts will investigate the effects of stenting and endarterectomy against intensive medical interventions alone.
Co-author Michael R. Jaff says it is still unknown whether patients with advanced carotid artery narrowing can be treated with medications alone.
"That is the outstanding remaining critical question," he says.
The study was published in the New England Journal of Medicine Feb 17.
Photo: Jeff Kubina | Flickr
