Document Detail


Stenting versus endarterectomy for treatment of carotid-artery stenosis.
MedLine Citation:
PMID:  20505173     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Carotid-artery stenting and carotid endarterectomy are both options for treating carotid-artery stenosis, an important cause of stroke.
METHODS: We randomly assigned patients with symptomatic or asymptomatic carotid stenosis to undergo carotid-artery stenting or carotid endarterectomy. The primary composite end point was stroke, myocardial infarction, or death from any cause during the periprocedural period or any ipsilateral stroke within 4 years after randomization.
RESULTS: For 2502 patients over a median follow-up period of 2.5 years, there was no significant difference in the estimated 4-year rates of the primary end point between the stenting group and the endarterectomy group (7.2% and 6.8%, respectively; hazard ratio with stenting, 1.11; 95% confidence interval, 0.81 to 1.51; P=0.51). There was no differential treatment effect with regard to the primary end point according to symptomatic status (P=0.84) or sex (P=0.34). The 4-year rate of stroke or death was 6.4% with stenting and 4.7% with endarterectomy (hazard ratio, 1.50; P=0.03); the rates among symptomatic patients were 8.0% and 6.4% (hazard ratio, 1.37; P=0.14), and the rates among asymptomatic patients were 4.5% and 2.7% (hazard ratio, 1.86; P=0.07), respectively. Periprocedural rates of individual components of the end points differed between the stenting group and the endarterectomy group: for death (0.7% vs. 0.3%, P=0.18), for stroke (4.1% vs. 2.3%, P=0.01), and for myocardial infarction (1.1% vs. 2.3%, P=0.03). After this period, the incidences of ipsilateral stroke with stenting and with endarterectomy were similarly low (2.0% and 2.4%, respectively; P=0.85).
CONCLUSIONS: Among patients with symptomatic or asymptomatic carotid stenosis, the risk of the composite primary outcome of stroke, myocardial infarction, or death did not differ significantly in the group undergoing carotid-artery stenting and the group undergoing carotid endarterectomy. During the periprocedural period, there was a higher risk of stroke with stenting and a higher risk of myocardial infarction with endarterectomy. (ClinicalTrials.gov number, NCT00004732.)
Authors:
Thomas G Brott; Robert W Hobson; George Howard; Gary S Roubin; Wayne M Clark; William Brooks; Ariane Mackey; Michael D Hill; Pierre P Leimgruber; Alice J Sheffet; Virginia J Howard; Wesley S Moore; Jenifer H Voeks; L Nelson Hopkins; Donald E Cutlip; David J Cohen; Jeffrey J Popma; Robert D Ferguson; Stanley N Cohen; Joseph L Blackshear; Frank L Silver; J P Mohr; Brajesh K Lal; James F Meschia;
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2010-05-26
Journal Detail:
Title:  The New England journal of medicine     Volume:  363     ISSN:  1533-4406     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-01     Completed Date:  2010-07-06     Revised Date:  2014-09-20    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  11-23     Citation Subset:  AIM; IM    
Copyright Information:
2010 Massachusetts Medical Society
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00004732
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Carotid Stenosis / mortality,  surgery,  therapy*
Endarterectomy, Carotid* / adverse effects
Female
Follow-Up Studies
Humans
Male
Middle Aged
Myocardial Infarction / epidemiology
Quality of Life
Stents* / adverse effects
Stroke / epidemiology,  prevention & control
Grant Support
ID/Acronym/Agency:
G0500495//Medical Research Council; R01 NS 038384/NS/NINDS NIH HHS; R01 NS038384/NS/NINDS NIH HHS; R01 NS038384-09/NS/NINDS NIH HHS
Investigator
Investigator/Affiliation:
W Clark / ; W Brooks / ; A Mackey / ; M Hill / ; A Buchan / ; P Leimgruber / ; V Mantese / ; C Timaran / ; L N Hopkins / ; D Chiu / ; R Begg / ; Z Jamil / ; R Hye / ; B Demaerschalk / ; O W Brown / ; G S Roubin / ; S Iyer / ; D Heck / ; R Farb / ; W Montanera / ; S K Lee / ; I Altafullah / ; G Ansel / ; A Sam / ; N Gonzales / ; M Campbell / ; J Choi / ; P Soukas / ; L Wechsler / ; D Clair / ; K Ouriel / ; M Reisman / ; W Gray / ; J Eidt / ; S Orlow / ; J Burke / ; S Sorenson / ; P J Casterella / ; M Malas / ; K Murphy / ; M Rinaldi / ; K Rosenfield / ; C Sternbergh / ; R Felberg / ; R McCann / ; T Smith / ; C O'Mara / ; A Hakaim / ; B Katzen / ; R Spetzler / ; A Pucillo / ; J Elmore / ; W Jordan / ; D Lew / ; R Powell / ; R Bulas / ; B Kluck / ; J Rapp / ; G Mishkel / ; F Weaver / ; M Nazzal / ; C Narins / ; R Molnar / ; M Eskandari / ; H Aronow / ; F Shawl / ; R Rosenwasser / ; H Chastain / ; M Foster / ; R Raabe / ; D Pelz / ; G Stotts / ; H Cloft / ; L Heller / ; W Knopf / ; B Reddy / ; K Hodgson / ; K Fraser / ; W Gray / ; J P Mohr / ; A Shepard / ; D Reddy / ; W Montanera / ; W Moore / ; E Chaikof / ; B Stern / ; S Johnson / ; R Zelman / ; A Evans / ; D Burkart / ; D Bandyk / ; P Karanjia / ; J Zarghami / ; A Arthur / ; J Barr / ; M Mehta / ; A Comerota / ; K Natarajan / ; K Krol / ; J Howington / ; D Selchen / ; M Schermerhorn / ; F W LoGerfo / ; S Laster / ; M Sanz / ; E Lopez del Valle / ; J Andriole / ; A Ringer / ; J Martin / ; R Guzman / ; P Teal / ; F Hellinger / ; G Petrossian / ; R B Berroya / ; M Bates / ; J Mills / ; M Golden / ; R Fairman / ; A Mansour / ; A MacBeth / ; H Madyoon / ; L A Iannone / ; K Hansen / ; J Biller / ; J Shuck / ; P Gobin / ; K Dauterman / ; J Melton / ; D Benckart / ; W Lesley / ; M Belkin / ; T Bajwa / ; S Myla / ; J Snell / ; H Shownkeen / ; A Abou-Chebl / ; T G Brott / ; R W Hobson / ; K W Beach / ; D J Cohen / ; J Cordell / ; D E Cutlip / ; R D Ferguson / ; L N Hopkins / ; G Howard / ; V J Howard / ; L Keene / ; B K Lal / ; J F Meschia / ; J P Mohr / ; W S Moore / ; J Popma / ; G S Roubin / ; A J Sheffet / ; F L Silver / ; S N Cohen / ; J Biller / ; J P Broderick / ; S Chaturvedi / ; M A Kalafut / ; E J Skalabrin / ; J L Blackshear / ; S P Glasser / ; R J Prineas / ; J Marsh / ; R Higashida / ; G Lamas / ; B Tilley / ; M Walker / ; G R Cutter /
Comments/Corrections
Comment In:
J Neurol. 2010 Jul;257(7):1221-3   [PMID:  20559840 ]
Kardiol Pol. 2010 Sep;68(9):1083-5   [PMID:  20859913 ]
Expert Rev Cardiovasc Ther. 2010 Oct;8(10):1379-81   [PMID:  20936923 ]
N Engl J Med. 2010 Oct 28;363(18):1766; author reply 1768   [PMID:  20979480 ]
N Engl J Med. 2010 Oct 28;363(18):1766-7; author reply 1768   [PMID:  21038510 ]
N Engl J Med. 2010 Oct 28;363(18):1767-8; author reply 1768   [PMID:  21038512 ]
Ann Intern Med. 2010 Nov 16;153(10):JC5-12   [PMID:  21079207 ]
Curr Cardiol Rep. 2011 Feb;13(1):1-2   [PMID:  20882370 ]
N Engl J Med. 2010 Oct 28;363(18):1767; author reply 1768   [PMID:  21038511 ]
N Engl J Med. 2010 Jul 1;363(1):80-2   [PMID:  20505174 ]
Erratum In:
N Engl J Med. 2010 Jul 8;363(2):198
N Engl J Med. 2010 Jul 29;363(5):498

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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