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Carotid Artery Stenting vs Carotid Artery Surgery: Is there a Difference?

Posted Apr 29 2010 4:26am

If you have a carotid stenosis you could be at an increased risk for a stroke. Carotid artery surgery (carotid endarterectomy) has been the treatment of choice for many years.  Carotid artery stenting is a less invasive option.  But for many years a controversy has existed – which is the better treatment? Carotid Endarterectomy or Carotid Stenting??

The CREST (Carotid Revascularization Endarterectomy Vs Stenting Trial) was devised specifically to answer this question and the results were presented recently at the 2010 International Stroke Conference.  Over 2,500 patients were enrolled in this trial from 117 US and Canadian sites.  So what did the study show??

There was no significant difference in the risk of stroke, heart attack or death during the procedure and no difference in stroke during the 2.5 year follow-up period.

People over 69 years of age had better outcomes with surgery and people younger than 69 had better outcomes with stenting.

There was no difference in outcomes among men and women or symptomatic and asymptomatic patients.

Dr Wesley Moore who was a co-principal investigator in this study stated that stroke rates were lower with carotid surgery but when heart attacks were added to the adverse outcomes the results of the two procedures became similar.

What must be remembered is that only the most experienced physicians and hospitals were included in this study.  So in order to receive the same benefits and low rate of adverse outcomes with either procedure you need to make sure you undergo a procedure at a hospital with a physician who is well experienced.

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