ICCS: Interim results show surgery is preferable to stenting

Published date : 27 April 2010
Article date : 27 April 2010

An interim safety analysis of the ongoing International Carotid Stenting Study (ICSS) offers strong evidence that carotid endarterectomy (CEA) is preferable to carotid stenting (CAS). ICSS investigators assessed the effectiveness of stenting and endarterectomy at preventing stroke, death, and procedure-related heart attacks in 1,713 patients with recently symptomatic carotid stenosis. Patients were randomly assigned to stenting (n=855) or surgery (n=858) and followed for up to 120 days after randomisation.

Findings showed that patients in the stent group had a significantly greater risk of stroke, death, or procedure-related heart attack within 120 days of randomisation –absolute risk 8.5% compared with 5.2% in the surgery group. Additionally, within 30 days of treatment the rate of stroke or death in the stent group was nearly twice the rate recorded in the surgery group. According to the authors, this difference was mainly due to a higher number of non-disabling strokes recorded in the stent group (36 versus 11 within 30 days of treatment), whereas the number of disabling strokes or deaths did not differ significantly (26 versus 18).

The authors concluded that, “Completion of long-term follow-up is needed to establish the efficacy of treatment with a carotid artery stent compared with endarterectomy. In the meantime, carotid endarterectomy should remain the treatment of choice for symptomatic patients suitable for surgery.”

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