SCOTTSDALE, ARIZ. — In a major study comparing carotid endarterectomy and carotid stenting, 2-year results show similar death and stroke rates for the two procedures, Dr. Rodney A. White said at an international congress on endovascular interventions sponsored by the Arizona Heart Foundation.
And those event rates appear to be better than one would expect based on some previously reported case series and studies, said Dr. White, the vascular surgery division chief at the Harbor-UCLA Medical Center, Los Angeles.
The 1-year results from the study, known as the CARESS (Carotid Revascularization Using Endarterectomy or Stenting Systems) trial, were recently published (J. Vasc. Surg. 2005;42:213–9). At 1 year post procedure, there were 30 deaths or strokes in the group of 254 patients who underwent carotid endarterectomy, for an event rate of 14%, and 13 deaths or strokes among the 143 patients who underwent carotid stenting, for an event rate of 10%.
By including acute myocardial infarctions that occurred among the patients the event rates were increased to 14% and 11%, respectively.
At the 2-year follow-up, the number of events increased somewhat, but the pattern remained the same. The death and stroke rate was 15% for the endarterectomy group and 13% for the stenting group. Adding acute myocardial infarctions did not change the event-rate percentages.
Dr. White did not report on the restenosis or reintervention rates at 2 years. In the previous 1-year follow-up report, restenosis occurred in 4% of the endarterectomy patients and 6% of the stenting patients, a difference that was not statistically significant.
Restenosis was defined as 75% narrowing, or 50% narrowing that required treatment.
A main purpose of the trial was to design a study that reflected current clinical practice, noted Dr. White. Hence, the patients were not randomized, and almost 70% of the patients in both groups had high-grade, carotid stenosis but were asymptomatic.
Moreover, 51% of the participating physicians—who were located in 14 different centers—were individuals who were able to do either procedure, Dr. White said.
“We now have 2-year data that [support] our original premise that we can get lower event rates both with carotid endarterectomy and carotid stents than are being reported in current clinical trials, if you have the option to do both,” Dr. White said.