Clinical Question: Is stenting safe...

Clinical Question: Is stenting safe and effective for high-risk patients with carotid stenosis?

Setting: Inpatient (any location) with outpatient follow-up

contemplation Design: Randomized controlled trial (single-blinded)

Allocation: Concealed

Synopsis: This cogitation included adults with a greater than 50 percent symptomatic lesion or a greater than 80 percent asymptomatic lesion and individual of the following characteristics: clinically significant heart disease, unadorned pulmonary disease, contralateral carotid stenosis or laryngeal power palsy, previous surgery or radiation to the neck age older than 80 years, or returning stenosis following carotid endarterectomy. The treating physicians had to agree that patients were candidates for surgery and stenting, smooth if they would not have qualified for previous clinical trials. Randomization and allocation concealment were appropriate, and results were assessed blindly. The mean age of the patients was 72 years, 67 percent were men and 26 percent had diabetes.

Of the 334 patients randomized to stenting or carotid endarterectomy, eight did not endure stenting and 16 did not go through surgery, primarily because of deterioration in their conditions. Therefore, the completed group of 334 patients made up the intention-to-treat analysis, while the smaller assign places to of 310 patients who received the assigned treatment made up the per-protocol analysis.

After common year, the likelihood of affliction or death at 30 days or ipsilateral hit or neurologic death from 31 days to single in kind year was not significantly different (55 versus 84 percent) The authors added myocardial infarction to the original combined expiration point and, in that way, were able to achieve statistical significance (122 versus 201 percent; P = 05 number penuryed to treat = 12). This image of post-study data analysis creates the potential for a bias in favor of finding an purport Symptomatic patients treated with stenting had similar issues to those treated with carotid endarterectomy; asymptomatic patients appeared to do better.

Bottom Line: Carotid stenting appears to provide similar issues to carotid endarterectomy for carefully rareed high-risk patients. This trial creates an optimal establish of circumstances for performance of the so the borderline advantage of stenting seen when myocardial infarction is included as an issue deserves further study. (Level of Evidence: 1b)

reflection Reference: Yadav JS, et al. sheltered carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J M October 7 2004;351:1493-501

Used with permission from Ebell M Carotid an option for high-risk patients. Accessed online November 24 2004 at: http://www.InfoPOEMs.com.

COPYRIGHT 2005 American Academy of Family Physicians

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