Stenting and carotid endarterectomy are equally safe and effective for patients at risk of stroke, according to a new study published on Feb. 17 in the New England Journal of Medicine. Both interventions produce similar resulting effects and doctors only have to evaluate which one is most likely to provide the best outcomes with the littlest risk, the paper states.
Called Asymptomatic Carotid Trial (ACT) I, the study focused on individuals without clinical manifestations of stroke. Researchers studied 1,453 people aged 79 and bellow, who had never shown stroke-related signs or symptoms but did have a 70-99 percent of narrowing in one carotid artery.
The study participants were randomly assigned to go through either carotid endarterectomy (364 individuals) or stenting (1,089 individuals). Researchers then carried out follow-ups one, six and 12 months later, then once each year throughout five years.
Experts found that no significant difference appeared between the two procedures regarding the risk of stroke or death 30 years after the intervention. Each of them had a low risk of about 3.5 percent.
Similarly, the long-term results did not show distinct characteristics. Carotid endarterectomy and stenting caused 97.8 percent and 97.3 percent, respectively, of the participants to remain free of stroke in the treated artery.
Learn how these procedures are executed
Carotid endarterectomy is a surgical method that consists of the removal of the inner lining of the affected artery if it has already thickened from plaque. This procedure is known for being the standard procedure among patients who do not tolerate open surgery.
On the other hand, carotid-artery stenting entails placing a flexible mesh tube into the part of the artery that appears blocked. Surgeons use a long catheter that delivers the mesh to the artery and is inflated to expand those narrowed pathways, enhancing blood flow.
ACT follows CREST, a similar study from 2010
In 2010, another team of researchers carried out a study called Carotid Revascularization Endarterectomy versus Stenting Trial (CREST). They examined 2502 patients and randomly assigned them with at least 70 percent carotid stenosis to stenting or endarterectomy.
They found that both procedures led to similar results. But, unlike the current study that focused only on patients with no stroke symptoms, CREST examined patients with and without signs of stroke. The only difference between both trials is that CREST researchers found the risk of minor stroke is a little higher in stenting immediately after the procedure.
“The trial shows impressive durability with both approaches over a 10-year follow-up. This opens the door for informed discussion between doctor and patient about both options”, as told to Medscape Medial News by Mark Alberts, MD, University of Texas Southwestern Medical Center in Dallas.
He added that there still was the slightly higher risk of stroke with stenting, but affirmed that without that small difference stenting would be the most effective in all cases.