New results from the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST), one of the largest randomized stroke prevention trials ever and a trial in which I participated, indicate that opening blocked neck arteries with a metal stent or surgery were equally durable.
Brajesh K. Lal, M.D., lead author of this analysis and associate professor of vascular surgery at the University of Maryland School of Medicine in Baltimore, says that, based on the results, “Patients and physicians can be reassured that both procedures are durable and that re-blockage rates are equivalent, so they can use different criteria to determine which procedure is right for a patient.”
The study took place at 117 centers in the United States and Canada over a nine-year period and compared the safety and effectiveness of carotid endarterectomy (CEA), a surgical procedure that involves cutting open the neck artery and scraping out the plaque to clear blocked blood flow, and carotid artery stenting (CAS), a newer and less-invasive procedure that involves threading a stent and expanding a small protective device in the artery to widen the blocked area and capture any dislodged plaque.
In 2004, the FDA approved cartoid stenting for patients with clogged carotid arteries who were at high risk of complications if they underwent a carotid endarterectomy. In May 2011 the FDA expanded that approval to allow patients at risk of stroke due to clogged neck arteries to be treated with the carotid stent. Currently, carotid artery stenting is only available to high-risk patients or those enrolled in a study.
I’ve performed about 150 cartoid stents to-date. Based on my experience, I agree that stents and surgery are equally durable and the results of either procedure are about the same. Patients benefit from the stent because it requires no anesthesia and there is no risk of nerve injury. My patients have been very pleased with the stent.
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