Carotid procedures test about equally

SAN ANTONIO — Two techniques for opening neck arteries, one surgical and one using a catheter, offer similar long-term effectiveness in preventing strokes and heart attacks, a large trial showed. But researchers reported February 26 at the International Stroke Meeting that slightly different risks show up for the two procedures in the first month after getting a procedure and in people over age 70.

Thomas Brott, a neurologist at the Mayo Clinic in Jacksonville, Fla., and his colleagues studied 2,502 people who had a partial blockage in a carotid artery, which supplies blood to the head. They randomly assigned roughly half to get each procedure.

In the surgery, called carotid endarterectomy, a surgeon opens up the neck artery and cleans out plaque that has built up. In the other procedure, called carotid stenting, doctors thread a catheter up to the carotid via blood vessels and insert a mesh cylindrical stent that props open the artery from the inside.

The new results showed that both procedures were equally effective over an average of 2.5 years of follow up, with people in both groups experiencing roughly a 7 percent risk of stroke, heart attack or death.

But in the first month after getting one of the two procedures, slightly more stented patients had a stroke than did surgery patients, while slightly more surgical patients had heart attacks than did stented patients. Stenting gave slightly better results in patients under age 70, while surgery seemed slightly preferable for people age 70 and older, Brott said. Doctors should take this into account, he says. 

The participants were treated at hospitals across North America.  Endarterctomy has been performed for decades. Stenting has been used for about 15 years, mainly in the heart, and was approved for carotid use six years ago.