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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis

Published on: May 14, 2013

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A prospective randomized trial comparing endarterectomy to stenting in severe asymptomatic carotid stenosis

Dallit Mannheim1, Ron Karmeli2

  • 1Department of Vascular Surgery, Carmel Medical Center, Haifa, Israel - dallit@gmail.com.

The Journal of Cardiovascular Surgery
|June 23, 2016
PubMed

Insights

Carotid artery stenting (CAS) and carotid endarterectomy (CEA) showed similar outcomes for preventing stroke in asymptomatic patients with severe carotid stenosis. Both procedures demonstrated comparable safety and long-term effectiveness in this patient group.

Area of Science:

  • Vascular Surgery
  • Neurology
  • Interventional Cardiology

Background:

  • Severe carotid stenosis is a significant risk factor for ischemic stroke.
  • Over 50% of carotid stenosis procedures are performed on asymptomatic patients.
  • Limited randomized trials specifically compare carotid endarterectomy (CEA) and stenting (CAS) in asymptomatic individuals.

Purpose of the Study:

  • To compare the periprocedural complications and long-term results of CEA and CAS in asymptomatic patients with severe carotid stenosis.
  • To evaluate stroke (CVA), transient ischemic attack (TIA), myocardial infarction (MI), and mortality rates.
  • To assess long-term outcomes including mortality, ipsilateral stroke/TIA prevention, and restenosis rates.

Main Methods:

  • Prospective randomized controlled trial (1:1 allocation) comparing CEA and CAS.
  • Inclusion criteria: asymptomatic patients with >70% carotid artery stenosis eligible for both procedures.
  • Primary endpoints: periprocedural complications (CVA, TIA, MI, death) and long-term results (mortality, stroke/TIA, restenosis).

Main Results:

  • 136 patients were randomized with a mean follow-up of 26 months.
  • No significant difference in short-term or long-term outcomes between CEA and CAS groups.
  • 30-day morbidity: 1 CVA per group, no MI. Long-term: 4 deaths per group (none from CVA), 1 TIA post-CAS, 3 restenosis post-CEA vs. 1 post-CAS.

Conclusions:

  • Carotid artery stenting (CAS) is a viable and maturing alternative to carotid endarterectomy (CEA) for selected asymptomatic patients.
  • Both procedures demonstrate comparable safety and efficacy in preventing stroke and long-term complications.
  • Advancements in CAS technology may further improve perioperative results, supporting its increased use.
Abstract

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