- Home
- Medical news & Guidelines
- Anesthesiology
- Cardiology and CTVS
- Critical Care
- Dentistry
- Dermatology
- Diabetes and Endocrinology
- ENT
- Gastroenterology
- Medicine
- Nephrology
- Neurology
- Obstretics-Gynaecology
- Oncology
- Ophthalmology
- Orthopaedics
- Pediatrics-Neonatology
- Psychiatry
- Pulmonology
- Radiology
- Surgery
- Urology
- Laboratory Medicine
- Diet
- Nursing
- Paramedical
- Physiotherapy
- Health news
- Fact Check
- Bone Health Fact Check
- Brain Health Fact Check
- Cancer Related Fact Check
- Child Care Fact Check
- Dental and oral health fact check
- Diabetes and metabolic health fact check
- Diet and Nutrition Fact Check
- Eye and ENT Care Fact Check
- Fitness fact check
- Gut health fact check
- Heart health fact check
- Kidney health fact check
- Medical education fact check
- Men's health fact check
- Respiratory fact check
- Skin and hair care fact check
- Vaccine and Immunization fact check
- Women's health fact check
- AYUSH
- State News
- Andaman and Nicobar Islands
- Andhra Pradesh
- Arunachal Pradesh
- Assam
- Bihar
- Chandigarh
- Chattisgarh
- Dadra and Nagar Haveli
- Daman and Diu
- Delhi
- Goa
- Gujarat
- Haryana
- Himachal Pradesh
- Jammu & Kashmir
- Jharkhand
- Karnataka
- Kerala
- Ladakh
- Lakshadweep
- Madhya Pradesh
- Maharashtra
- Manipur
- Meghalaya
- Mizoram
- Nagaland
- Odisha
- Puducherry
- Punjab
- Rajasthan
- Sikkim
- Tamil Nadu
- Telangana
- Tripura
- Uttar Pradesh
- Uttrakhand
- West Bengal
- Medical Education
- Industry
Carotid artery surgery and stenting have similar long-term effects on stroke: Lancet
Sophia Antipolis, France - Carotid artery surgery and stenting have comparable long-term effects on fatal or disabling stroke in asymptomatic patients with severe carotid artery stenosis. That's the finding of late breaking research presented in a Hot Line session today at ESC Congress 20211 and published simultaneously in The Lancet.
Patients with severe carotid artery stenosis are at elevated risk of stroke and both carotid artery stenting (CAS) and carotid artery surgery, also called carotid endarterectomy (CEA), can restore patency and reduce the long-term risk of stroke. Nationwide registry data from Germany have shown among asymptomatic patients, CAS and CEA are both associated with an approximately 1% risk of disabling stroke or death.2 Comparative data are lacking on the long-term protective effects of the two procedures.
ACST-2 was the largest trial to compare the long-term effect of CAS versus CEA on stroke in asymptomatic patients with a severely narrowed carotid artery that had not yet caused a stroke. The trial enrolled patients with severe carotid artery narrowing (60% or more reduction in diameter on ultrasound) found by chance, but with no recent stroke or other neurological symptoms. Participants were thought by their doctor to need CAS or CEA but both doctor and patient were substantially uncertain about which procedure was preferable.
A total of 3,625 patients were enrolled from 130 centres in 33 countries. Participants were randomly allocated 1:1 to CAS or CEA and followed up for an average of five years. The main outcomes were: 1) procedural risks (morbidity and mortality within one month after the procedure); and, most importantly, 2) non-procedural stroke, subdivided by severity.
Regarding procedural risks, 1% of patients in both groups had a disabling stroke or died within 30 days (15 allocated to CAS and 18 to CEA) and 2% had a non-disabling procedural stroke (48 allocated to CAS and 29 to CEA).
The main outcome was five-year non-procedural stroke; fatal or disabling stroke occurred in 2.5% of patients in each group, for a rate ratio (RR) of CAS versus CEA of 0.98 (95% confidence interval [CI] 0.64–1.48; p=0.91), and any non-procedural stroke occurred in 5.3% of the CAS group versus 4.5% of the CEA group (RR 1.16; 95% CI 0.86–1.57; p=0.33). A meta-analysis of this and all other major trials of CAS versus CEA yielded a similarly non-significant result for any stroke (RR 1.11; 95% CI 0.91–1.32; p=0.21).
Principal investigator Professor Alison Halliday of the University of Oxford, UK said: "We have shown that, for patients with a severely narrowed carotid artery, stenting and surgery have similar effects on the chances of having a disabling or fatal stroke. The risk from each procedure is about 1%. After that, however, the annual risk over the next five or more years is halved, from 1% down to 0.5% per year."
Hina Zahid Joined Medical Dialogue in 2017 with a passion to work as a Reporter. She coordinates with various national and international journals and association and covers all the stories related to Medical guidelines, Medical Journals, rare medical surgeries as well as all the updates in the medical field. Email:Â editorial@medicaldialogues.in. Contact no. 011-43720751
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751