Carotid artery stenting not superior to medical therapy in elderly asymptomatic carotid stenosis patients

USA: In a recent research of older male people, there was no difference in the treatment of asymptomatic carotid stenosis between carotid artery stenting (CAS) and medical therapy (MT). The findings of this study were published in the journal Stroke.

No completed trials have known to compare carotid artery stenting with medical therapy. Considering this, Salomeh Keyhani and colleagues did this study to investigate the efficacy of CAS against MT in individuals with asymptomatic carotid stenosis. 

Researchers conducted a retrospective cohort analysis of 219 979 Veterans 65 years of age who had carotid imaging for asymptomatic carotid stenosis in the US Veterans Health Administration between 2005 and 2009. They built a sample of patients who got MT (n=2509) and a comparable group of patients who received CAS (n=551) and tracked them for 5 years. Using target trial methods, the researchers calculated weighted Kaplan-Meier curves and evaluated the risk of nonfatal and fatal stroke in each group during a 5-year period of follow-up. Also estimated are the cumulative incidence functions for fatal and nonfatal strokes, taking non stroke deaths into account as competing hazards.

The results of this study stated as follow:

1. CAS was given to 551 patients, whereas MT was given to 2509 individuals.

2. In the CAS arm, the observed risk of stroke or death (perioperative complications) within 30 days was 2.2%.

3. Using the target trial approach, the 5-year risk of fatal and nonfatal stroke was similar among CAS (6.9%) and MT (7.1% ; risk difference, 0.1%) patients.

4. The risk difference between the two arms remained nonsignificant in an analysis that included the competing risk of mortality (risk difference, 1.5%).

In conclusion, although hampered by a paucity of data in women, these real-world data imply that CAS does not provide a therapeutic advantage when compared to MT in individuals with asymptomatic carotid artery stenosis.

Reference: 

Keyhani S, Cheng EM, Hoggatt K, Austin PC, Madden E, Hebert PL, Halm EA, Naseri A, Johanning J, Abraham A, Bravata DM. Comparative Effectiveness of Carotid Stenting to Medical Therapy Among Patients With Asymptomatic Carotid Stenosis. Stroke. 2022, doi:10.1161/STROKEAHA.121.036178. Epub ahead of print. PMID: 35164531.

Keywords: carotid artery, stenosis, stenting, neurovascular, stroke, geriatrics, cardiac health, endarterectomy,