Carotid stenting suffers a setback
The debate between carotid artery stenting (CAS) and carotid endarterectomy (CEA) - the surgical approach - for treating a narrowing of the carotid artery in the neck to prevent stroke has tipped in favour of the more proven procedure of operation.
Every year in Germany, 200,000 people suffer from a stroke. Around 30,000 are caused by carotid stenosis, a narrowing of the carotid artery because of plaque. Removal of this plaque is one of the most successful means of preventing strokes in these patients, and the benefits outweigh the risks of further strokes or death after operations. Past clinical trials reveal that in professional hands, the perioperative risk of stroke in symptomatic patients is 6% and in asymptomatic patients as low as 3%.
Some physicians questioned the conclusions reached by these trials because both were halted before they were finished, resulting in fewer numbers of patients and leaving them unable to prove statistically significant results from which to draw definitive conclusions.
D. Peter Bell is a vascular surgeon at the Leicester Royal Infirmary in the United Kingdom and an outspoken critic of carotid stenting. He says: ‘As far as symptomatic patients are concerned, the EVA-3S and SPACE trials have shown no benefit for CAS in patients with symptoms who need treatment.’
For these patients, a risk of having a stroke without any treatment would be as low as 2% a year, rendering unacceptable the results of the SAPPHIRE trial that showed a perioperative stroke risk rate of 5.8% at 30 days.
With no trials demonstrating clear evidence in favour of stenting, this procedure should not be used more widely. Dr Bell warns: ‘These [EVA-3S and SPACE] trial results show that the CAS procedure is dangerous even in the hands of experts and should not be used more widely. Otherwise, disaster will occur.’
This article was published on 12/27/2006