Protected Carotid-Artery Stenting versus Endarterectomy in High-Risk Patients

• Published in: The New England journal of medicine Vol. 351; no. 15; pp. 1493 - 1501
• Main Authors: Yadav, Jay S, Wholey, Mark H, Kuntz, Richard E, Fayad, Pierre, Katzen, Barry T, Mishkel, Gregory J, Bajwa, Tanvir K, Whitlow, Patrick, Strickman, Neil E, Jaff, Michael R, Popma, Jeffrey J, Snead, David B, Cutlip, Donald E, Firth, Brian G, Ouriel, Kenneth
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 07-10-2004
• Subjects: Adult; Aged; Aged, 80 and over; Angioplasty; Angioplasty, Balloon - instrumentation; Biological and medical sciences; Cardiology; Carotid Stenosis - mortality; Carotid Stenosis - surgery; Carotid Stenosis - therapy; Comorbidity; Disease-Free Survival; Embolism - prevention & control; Embolism - therapy; Endarterectomy, Carotid; Equipment Design; General aspects; Humans; Incidence; Laboratories; Medical sciences; Middle Aged; Myocardial Infarction - prevention & control; Patients; Physicians; Risk Factors; Stents; Stroke - prevention & control; Surgical outcomes; Ultrasonic imaging; Veins & arteries; Human; Medicine; High risk; Surgery; Carotid; Instrumentation therapy; Endarteriectomy; Protection; Stent; Comparative study
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa040127

Patients with severe carotid-artery stenosis, who are at high risk for stroke, usually undergo endarterectomy. This clinical trial compared endarterectomy and carotid stenting with the use of a stent with an emboli-protection device in patients with severe carotid-artery stenosis. Stenting was found to be not inferior to endarterectomy with respect to clinical outcome. Therefore, the less invasive approach may be an acceptable alternative among patients with high-risk carotid-artery stenosis.
The less invasive approach may be an acceptable alternative among patients with high-risk carotid-artery stenosis.
Several trials have shown carotid endarterectomy to be superior to medical management for the prevention of stroke in patients with symptomatic or asymptomatic carotid-artery stenosis.
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The patients in the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and those in the Asymptomatic Carotid Atherosclerosis Study (ACAS) were carefully selected and had low rates of surgical complications.
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Many patients for whom surgery poses a high risk, however, routinely undergo carotid endarterectomy in clinical practice and were excluded from these trials, and such patients have outcomes that are substantially worse than those reported in these trials.
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During the past decade, carotid . . .