The Carotid Conundrum: Evaluating Stenting Versus Endarterectomy in Modern Practice
Stenting vs. Surgery in Carotid Stenosis: Age and Risk Considerations
DOI:
https://doi.org/10.37609/srinmed.23Keywords:
Long Term Potentiation, Occupational Health, treatmentAbstract
Objective:
This review aims to assess the clinical outcomes, safety, and efficacy of carotid artery stenting (CAS) compared to carotid endarterectomy (CEA) for managing carotid artery stenosis, emphasizing risk stratification based on patient age and symptomatic status. Proper risk stratification is vital to achieve personalized treatment and improve outcomes.
Methods:
We analyzed data from randomized controlled trials (RCTs) and meta-analyses comparing CAS and CEA in symptomatic and asymptomatic patients. Notably, recent studies like Müller et al. (2021) offered detailed insights into how outcomes vary across patient subgroups. Primary endpoints include perioperative stroke, myocardial infarction (MI), and restenosis, while secondary outcomes such as quality of life and recovery times were considered.
Results:
CAS was linked to a higher risk of periprocedural stroke, particularly in older patients, while CEA showed a higher incidence of perioperative MI. Long-term follow-up revealed that CAS had a higher rate of restenosis, particularly in patients with calcified plaques. CEA was shown to reduce perioperative stroke risk significantly, especially in patients over 70 years old, highlighting age as a critical factor in determining long-term success. Thorough preoperative imaging is essential when selecting candidates for CAS, particularly in cases with significant calcification.
Conclusion:
CAS is suitable for younger, low-risk patients, but CEA remains the optimal choice for older individuals due to its lower stroke risk. Treatment should be individualized, accounting for factors like age, comorbidities, and anatomical considerations.
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References
North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991;325(7):445-53. DOI: 10.1056/NEJM199108153250701
European Carotid Surgery Trialists’ Collaborative Group. Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet. 1998;351(9113):1379-87. DOI: 10.1016/S0140-6736(97)09292-1
Murad MH, Shahrour A, Montori VM, et al. Endarterectomy vs stenting for carotid artery stenosis: a systematic review and meta-analysis. J Vasc Surg. 2008;48(2):487-93. DOI: 10.1016/j.jvs.2008.04.028
Nanna MG, Gomes P, Njoh RF, Ward C, Attaran RR, Mena C. Carotid artery stenting versus carotid endarterectomy. Postgrad Med J. 2016;92(1091):532-9. DOI: 10.1136/postgradmedj-2015-133689
Li Y, Bai Y, Zhang Y, Zhao M. Long-term efficacy and safety of carotid artery stenting versus endarterectomy: a meta-analysis of randomized controlled trials. PLoS One. 2017;12(7). DOI: 10.1371/journal.pone.0180804
Economopoulos KP, Sergentanis TN, Mylonas KS, et al. Carotid artery stenting versus carotid endarterectomy: a comprehensive meta-analysis of short-term and long-term outcomes. Stroke. 2011;42(3):687-92. DOI: 10.1161/STROKEAHA.110.599035
Müller MD, Stöckli R, Walthert F, et al. Carotid artery stenting versus endarterectomy for treatment of carotid artery stenosis. Stroke. 2021;52(1). DOI: 10.1161/STROKEAHA.120.033610
Meier P, Knapp G, Tamhane U, et al. Short term and intermediate term comparison of endarterectomy versus stenting for carotid artery stenosis: systematic review and meta-analysis of randomised controlled clinical trials. BMJ. 2010;340. DOI: 10.1136/bmj.c467
Giudice R, Spataro C. Treatment of carotid stenosis: surgery and stent in comparison. Eur Heart J Suppl. 2021;23(Supplement_E). DOI: 10.1093/eurheartj/suab099
Fraser JF, Wooster MA, Hasan DM, Turner RD, Wolfe SQ. Decoding the data: a comment on the AHA/ASA 2023 Guideline for the Management of patients with Aneurysmal Subarachnoid Hemorrhage. J Neurointerv Surg. 2023;15(9):835-7. DOI: 10.1136/neurintsurg-2023-019123
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