Stenting Found Less Safe Than Surgery for Carotid Artery Stenoses

A new study has found that stroke and death rates are higher in patients who received carotid artery stents, compared to those treated by endarterectomy.

Researchers at University Medical Center (Utrecht, The Netherlandsl) followed 200 patients participating in a substudy of the large randomized International Carotid Stenting Study (ICSS), which included five centers with 108 patients randomly assigned to carotid artery stent, and 92 patients randomly assigned to endarterectomy. Magnetic resonance imaging (MRI) scans were performed preprocedure, immediately postprocedure, and again 30 days later.

The researchers found that the early post-operative MRI brain scans showed evidence of new ischemia in 50 patients in the carotid artery stent group (46.3%) versus 13 patients in the endarterectomy group (14.1%); on the 30-day scans, which were performed with diffusion-weighted imaging, there were 28 abnormalities in the stent group (32.2%), compared to only six abnormalities in the endarterectomy group (7.9%). The study results were presented at the 36th annual VEITH symposium, held during November 2009 in New York (NY, USA).

"These spots in the brain may lead to vascular dementia. Similar evidence of new ischemia in the brain following carotid artery stenting in symptomatic patients is being picked up by investigators in other parts of the world,” said lead author and study presenter Prof. Frans Moll, M.D., head of the department of vascular surgery. "ICSS confirms that for the moment, outcomes with surgery are more reliable in symptomatic patients in terms of safety. Surgery removes plaque, but stents 'push the plaque behind the wallpaper,' and the plaque continues to exert damage. Perhaps this could change if better, safer stents are developed.”

Vascular dementia is the second most common form of dementia after Alzheimer's disease (AD) in older adults; early detection and accurate diagnosis are important, as vascular dementia is at least partially preventable. The term refers to a group of syndromes caused by different mechanisms, all resulting in vascular lesions in the brain. The main subtypes of this disease described at the moment are: mild cognitive impairment, multi-infarct dementia, vascular dementia due to a strategic single infarct, vascular dementia due to hemorrhagic lesions, small vessel disease, and mixed Alzheimer's and vascular dementia. In fact, vascular dementia and Alzheimer's disease often coexist, especially in older patients with dementia.

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