In a
study published in NEJM Rosenfield et
al report the findings of a trial that compared carotid artery stenting with
“embolic protection” to carotid endarterectomy.
In this trial, the authors compared
carotid-artery stenting with “embolic protection” and carotid endarterectomy in
1453 patients who were 79 years of age or younger who had severe carotid
stenosis and were asymptomatic. Patients
were followed for up to 5 years. The primary composite end point of death,
stroke, or myocardial infarction within 30 days after the procedure or
ipsilateral stroke within 1 year was tested at a non-inferiority margin of 3
percentage points.
The rate of stroke or death within 30
days was 2.9% in the stenting group and 1.7% in the endarterectomy group
(P=0.33). From 30 days to 5 years after the procedure, the rate of freedom from
ipsilateral stroke was 97.8% in the stenting group and 97.3% in the
endarterectomy group (P=0.51), and the overall survival rates were 87.1% and
89.4%, respectively (P=0.21). The cumulative 5-year rate of stroke-free
survival was 93.1% in the stenting group and 94.7% in the endarterectomy group
(P=0.44).
The authors
concluded that stenting was not inferior to
endarterectomy with regard to the rate of the primary composite end point at 1
year. In analyses that included up to 5 years of follow-up, there were no
significant differences between the study groups in the rates of
non–procedure-related stroke, all stroke, and survival.
N Engl J Med 2016; 374:1011-1020
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