Stenting Versus Endarterectomy for Carotid Artery Stenosis: What Are the Trade-Offs?

Mid-term CREST findings indicate that surgery is more effective for stroke prevention, but stenting has some advantages.

The use of stenting as an alternative to surgical endarterectomy for treatment of carotid artery stenosis is controversial (JW Cardiol Apr 7 2010). In this North American multicenter trial, 2502 adults with carotid stenosis (baseline age, 69) were randomized to undergo endarterectomy or stenting. Forty-seven percent of patients were asymptomatic, and embolic protection was employed in 96% of stenting procedures.

The 4-year estimate of the primary combined endpoint of stroke, myocardial infarction (MI), and death did not differ significantly between the stenting and endarterectomy groups (7.2% and 6.8%, respectively). During a median follow-up of 2.5 years, the stroke rate was higher in the stenting group than in the endarterectomy group (4.1…

Reviewing Author

Howard C. Herrmann, MD

Disclosures

Consultant/Advisory BoardAffluent Medical; Artedrone; Caranx; Johnson & Johnson; Medtronic; Prolifagen; Wells Fargo

EquityMicrointerventional Devices, Inc.

RoyaltiesUniversity of Pennsylvania

Grant/Research SupportAbbott Vascular; Edwards Lifesciences; Johnson & Johnson; Medtronic

Editorial BoardsCatheterization and Cardiovascular Interventions; Journal of the American College of Cardiology; Circulation: Cardiovascular Interventions; JACC Cardiovascular Interventions; JACC Case Reports; JSCAI

Leadership Positions in Professional SocietiesHeart Valve Collaboratory (Scientific Committee Member, Chair of the Publications Committee)