The risk of reocclusion after two procedures used to prevent strokes in patients with blocked carotid arteries

This trial compared the rate of restenosis (obstruction of the artery for a second time after it has been opened) after either of two procedures used to treat carotid artery stenosis: carotid endarterectomy and carotid artery stenting.

Carotid artery stenosis is a condition in which the main arteries supplying blood to the brain – the carotid arteries – are narrowed (due to fat accumulation within their walls). This reduces blood flow to the brain, and may lead to a stroke. Until recently, severe carotid artery stenosis was treated by carotid endarterectomy. This procedure includes surgery to open the carotid artery and remove the fat deposits that obstruct it. Recently an alternative procedure for the treatment of carotid stenosis has been developed. This new method, called carotid artery stenting, involves stent (a wire mesh tube that holds the artery open) placement within the blocked artery. This procedure is non-surgical and preformed by inserting a small wire into the artery of the groin or the hand (a procedure called catheterization). Prior studies have shown that the two procedures are equally safe judged by the risk of heart attack, stroke, or death during and right after the operation. The present analysis evaluated the risk of restenosis of the treated artery during the 2 years after the procedure. 

2191 patients with stenosis of the carotid artery were assigned to receive either carotid artery stenting or carotid endarterectomy. Restenosis was assessed by ultrasound after 1, 6, 12, 24, and 48 months. After 2 years, 58 (6%) patients who underwent carotid artery stenting, and 62 (6.3%) patient who underwent carotid endarterectomy experienced restenosis of the affected carotid artery. Women, diabetics, and patients with high cholesterol levels were at increased risk of restenosis regardless of the treatment received. Smokers had increased risk of restenosis after endarterectomy.

This study showed that carotid artery stenting is as effective as carotid endarterectomy in treating patients with carotid artery stenosis. The rate of restenosis after 2 years did not differ substantially between the two procedures, and was relatively low regardless of the treatment chosen.

It should be noted that the compared groups were not entirely balanced: patients who underwent carotid endarterectomy had their procedures slightly later than did those receiving carotid artery stenting, and more patients undergoing stenting received blood thinners (e.g. aspirin and/or plavix) than did those assigned to endarterectomy.

Consult with your physician regarding the optimal treatment for carotid artery stenosis and how to reduce the risk of restenosis.