Stenting safe and effective for long-term stroke prevention
14 October 2014
Using stents to keep neck arteries open is just as effective as invasive neck surgery for long-term prevention of fatal and disabling strokes, reports an international trial led by UCL funded by the Medical Research Council and Stroke Association.
The research paper, published today in the Lancet, was authored by researchers from UCL, Basel University, Switzerland, the London School of Hygiene & Tropical Medicine, the University Medical Center Utrecht, Netherlands, Sheffield Teaching Hospitals NHS Foundation Trust, and Newcastle University.
In the UK, carotid artery disease is most commonly treated by an invasive surgical procedure called endarterectomy. Stenting is an alternative procedure which is less invasive, causing only minor bruising in the groin, no risk of nerve damage and a lower heart attack risk than endarterectomy.
The study followed 1,713 patients with carotid artery disease, of whom 855 were assigned to stenting and 858 to endarterectomy, for up to 10 years. The median follow-up was 4.2 years. Both techniques were found to be equally good at preventing fatal and disabling strokes, but stented patients were slightly more likely to have minor strokes without long-term effects. The risk of any stroke in five years was 15.2% in the stenting group compared to 9.4% in the endarterectomy group, but the additional strokes were minor and had no impact on long-term quality of life.
Professor Brown added: “One of the issues is that there are not many centres in this country that currently offer stenting as an option so the patient choice is not there. Now that we know stenting is effective in the long term, more staff should be trained to carry out the procedure and gain experience. Otherwise there is a vicious cycle where nobody at a centre has stenting experience so patients are only offered endarterectomy and staff cannot learn or observe the procedure. In other countries, stenting is more widespread and the safety of the procedure improves as staff gain experience.”
- UCL press release
- Bonati, Dobson, Featherstone, Ederle, van der Worp, de Borst, Mali, Beard, Cleveland, Engelter, Lyrer, Ford, Dorman, Brown (for the International Carotid Stenting Study investigators) Long-term outcomes after stenting versus
endarterectomy for treatment of symptomatic carotid stenosis: the
International Carotid Stenting Study (ICSS) randomised trial. Lancet. Available online 14 October 2014. doi:10.1016/S0140-6736(14)61184-3