European Series: Carotid Stent vs. Endarterectomy

By Timothy F. Kirn

SCOTTSDALE, ARIZ. -- Carotid stenting results appear to be similar to endarterectomy for at least 5 years after the procedure, according to a cohort of 2,172 patients treated at four European centers.

In the cohort, enrolled prospectively between 1993 and 2004, the rate of ipsilateral major stroke or death from any cause was 4% at 1 year, 10% by 3 years, and 16% by 5 years, among the 138 patients followed, Dr. Patrick Peeters said at an international congress on endovascular interventions sponsored by the Arizona Heart Foundation.

The restenosis rates were 1% at 1 year, 2% at 3 years, and 3% at 5 years (139 patients), where restenosis was considered to be 50% narrowing imaged with ultrasound, noted Dr. Peeters, head of the department of cardiovascular and thoracic surgery at Imelda Hospital, Bonheiden, Belgium.

Previous studies reported restenosis rates at 1 year ranging from 3% to 8%. Moreover, though the earliest studies of carotid stenting had major, perioperative complication rates as high as 9%, 99.7% of cases in this series were technically successful. The results with stenting also compare well with endarterectomy, he noted. The European Carotid Surgery Trial reported a rate of major stroke or death of 15% at 3 years, very similar to the 13% rate of this series.

A number of different, self-expanding stents were used in the series, chosen by the individual interventionalists at the time of the procedure, with the most common being a closed-cell, cobalt chromium alloy stent, used in 62% of the patients. And 4% of patients received only balloon dilation.

Although stenting did not make a significant difference in the stroke/death rate compared with ballooning only, it did in the restenosis rate. Restenosis at 5 years was only 3% in the stented patients, but it was 15% in the ballooned-only patients.

Predilatation of the artery before stent placement also made a significant difference, Dr. Peeters said. Of stented patients, 30% were predilated. Their stroke and death rate at 5 years was 10% (33 patients) versus 17% for those not predilated. There was no difference in stroke and death in the series between the patients who were symptomatic or asymptomatic.