Stenting versus endarterectomy in the long-term

This paper studied the long-term outcome of stenting versus endarterectomy in patients with coronary-artery stenosis. The authors concluded that there was no 10 year difference in risk of stroke, heart attack and death between patients who received stenting or endarterectomy. 

In patients with carotid-artery stenosis, blood vessels supplying the brain become narrowed. Most commonly, this is due to a build-up of substances called plaque in the blood vessel. This reduces blood supply, and increases the risk of strokes (not enough blood going to the brain), and death. Stenting is a surgical procedure where a stent (mesh wire tube) is placed into a blood vessel, allowing blood to flow smoothly. Endarterectomy is a surgical procedure where plaque that has built-up in the blood vessel is removed. Initial studies found that there was no difference in outcome whether patients received stenting or endarterectomy after 4 years.

The authors continued the initial study with a long-term study. 2502 patients were studied initially. 1607 patients were followed over a longer time (up to 10 years). Patients who had long-term follow-up were more likely to have narrowed blood vessels without symptoms or abnormal levels of fat (such as cholesterol) but were less likely to have diabetes or to be current smokers.

The 10-year risk of any stroke, heart attack, or death did not differ significantly between the patients receiving stenting or patients receiving endarterectomy in the period during, before and after the surgery. At 10 years, 11.8% of patients who received stents had a stroke or heart attack or died. 9.9% of patients who received endarterectomy had a stroke or heart attack or died. There were also no differences from the first year to the ninth year between patients who received stenting or endarterectomy.

After the surgery, major stroke occured in 6.9% of patients who had stenting and 5.6% of those who underwent endarterectomy. This difference was not significant.

The authors concluded that there was no significant difference between patients who underwent stenting and those who underwent endarterectomy with regards to the risk of stroke, heart attack, or death before, during and after the surgery.