THURSDAY, Oct. 24 (HealthDay News) -- For patients being treated
for a blockage in the artery that supplies blood to the head,
inserting a stent may raise the risk of stroke more in elderly
patients than in younger patients, a large new evidence review
However, death risk was similar for older and younger patients
receiving stents. And it was not as high as it was for older
patients who underwent a different surgical procedure -- called
endarterectomy -- to unblock the clogged artery.
The report was published Oct. 23 in the online edition of
An ongoing debate exists about the best treatment for the
condition known as carotid artery atherosclerosis. The issue is
whether placing a tiny mesh tube (a stent) to keep the
plaque-clogged neck artery open is safer for older patients than
endarterectomy -- a surgical procedure to open the artery and
remove the plaque.
For the new study, a research team led by Dr. George Antoniou,
of the Hellenic Red Cross Hospital in Athens, Greece, reviewed 44
studies that looked at opening the carotid arteries with a carotid
endarterectomy or by placing a stent.
These studies included more than 500,000 patients who had a
carotid endarterectomy and about 75,000 patients who had a stent
placed. In this type of study, called a meta-analysis, researchers
try to find common patterns in a number of diverse, but similar
Despite the large number of people included in these studies,
Antoniou's group found the quality of the studies was poor -- with
each using different criteria in classifying older and younger
The researchers, however, concluded that carotid endarterectomy
had similar outcomes in terms of stroke among older and younger
patients, but was more often fatal among older patients.
In addition, both procedures seemed to increase the risk of
heart attack in older patients. Older patients who had a stent
placed, however, had a greater risk of stroke than younger
patients, the investigators found.
Two experts compared the findings from the new review with those
of a previous, landmark study.
"This study complements and confirms the data from the Carotid Revascularization Endarterectomy Versus Stenting Trial [CREST] that suggests that endarterectomy has a lower stroke risk than stenting in older patients," said Dr. Ralph Sacco, chairman of neurology at the University of Miami Miller School of Medicine. He had no part in the study.
The CREST study was published in October 2010 in the journal
Stroke. Although the number of deaths was slightly greater
in the elderly for endarterectomy in CREST, the absolute risk of
dying was not that different and actually less than with stenting
for both older and younger age groups, Sacco said.
"For patients under age 70, both procedures are effective in reducing the risk of recurrent stroke due to carotid narrowing after a minor stroke," Sacco said. "For patients over age 70, endarterectomy may have the advantage as of now, but better stents and future devices could change the picture."
Another expert said the latest findings don't really break new
Dr. Richard Libman, vice chair of neurology at the Long Island
Jewish Medical Center in New Hyde Park, N.Y., said the "extensive
review of the literature does not add significantly to what has
been found and what has been practiced, based on the largest and
most rigorous clinical trial, which compared carotid endarterectomy
to carotid stenting."
While both procedures have their advantages and disadvantages,
endarterectomy could still be considered the "gold standard"
treatment but stenting is a very close second, he said.
"In addition, there are certain patients in whom endarterectomy has intrinsically high risk, such as those with severe heart or lung disease, or those who have had previous radiation to the neck, a carotid artery which had previously undergone surgery or complete occlusion of the carotid artery on the other side of the neck," Libman said.
These high-risk patients have been studied in another clinical
trial, and have been found to have fewer complications with
stenting than with endarterectomy, he said. "The picture,
therefore, is not clear-cut and the decision for management in
every case of carotid artery narrowing needs to be individualized,"
To learn more about carotid artery stenting, visit the
U.S. National Library of Medicine.
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