Surgery outperformed the use of stents in a French trial of patients who had warning symptoms of stroke because of blockage of the carotid arteries, the main blood vessels to the brain. Indeed, the trial was cut short “for reasons of both safety and futility,” said a report in the Oct. 19 issue of the New England Journal of Medicine. The incidence of stroke or death in the 30 days and six months after a procedure was about twice as high for patients given a stent, a tube-like device to keep an artery open, than for those who had the surgery called endarterectomy.
“The conclusion of the paper is that patients benefit from endarterectomy and not stenting if they have symptomatic stenosis [blockage],” said Dr. Jean-Louis Mas, professor of neurology at the Hospital Sainte-Anne in Paris, and lead author of the report.
But that conclusion doesn’t necessarily apply to people with carotid blockage who show no symptoms and are at high risk of complications from surgery because of conditions such as severe heart disease, Mas added. “In our study, we did not include patients at high risk from carotid surgery,” he noted.
The decision about stenting or surgery is not always easy to make, Furlan said. The presence of other medical conditions, notably heart disease, must be taken into consideration. “If the patient has a bad heart, it’s not clear whether anything should be done,” he said. “If the patient has no symptoms and a good five-year life expectancy, stenting might be a little safer because of a lower risk of heart attack.”