Stenting versus endarterectomy for treatment of carotid-artery stenosis

Thomas G. Brott, Robert W. Hobson, George Howard, Gary S. Roubin, Wayne Clark, William Brooks, Ariane Mackey, Michael D. Hill, Pierre P. Leimgruber, Alice J. Sheffet, Virginia J. Howard, Wesley S. Moore, Jenifer H. Voeks, L. Nelson Hopkins, Donald E. Cutlip, David J. Cohen, Jeffrey J. Popma, Robert D. Ferguson, Stanley N. Cohen, Joseph L. Blackshear & 4 others Frank L. Silver, J. P. Mohr, Brajesh K. Lal, James F. Meschia

Research output: Contribution to journalArticle

1829 Citations (Scopus)

Abstract

BACKGROUND: Carotid-artery stenting and carotid endarterectomy are both options for treating carotid-artery stenosis, an important cause of stroke. METHODS: We randomly assigned patients with symptomatic or asymptomatic carotid stenosis to undergo carotid-artery stenting or carotid endarterectomy. The primary composite end point was stroke, myocardial infarction, or death from any cause during the periprocedural period or any ipsilateral stroke within 4 years after randomization. RESULTS: For 2502 patients over a median follow-up period of 2.5 years, there was no significant difference in the estimated 4-year rates of the primary end point between the stenting group and the endarterectomy group (7.2% and 6.8%, respectively; hazard ratio with stenting, 1.11; 95% confidence interval, 0.81 to 1.51; P = 0.51). There was no differential treatment effect with regard to the primary end point according to symptomatic status (P = 0.84) or sex (P = 0.34). The 4-year rate of stroke or death was 6.4% with stenting and 4.7% with endarterectomy (hazard ratio, 1.50; P = 0.03); the rates among symptomatic patients were 8.0% and 6.4% (hazard ratio, 1.37; P = 0.14), and the rates among asymptomatic patients were 4.5% and 2.7% (hazard ratio, 1.86; P = 0.07), respectively. Periprocedural rates of individual components of the end points differed between the stenting group and the endarterectomy group: for death (0.7% vs. 0.3%, P = 0.18), for stroke (4.1% vs. 2.3%, P = 0.01), and for myocardial infarction (1.1% vs. 2.3%, P = 0.03). After this period, the incidences of ipsilateral stroke with stenting and with endarterectomy were similarly low (2.0% and 2.4%, respectively; P = 0.85). CONCLUSIONS: Among patients with symptomatic or asymptomatic carotid stenosis, the risk of the composite primary outcome of stroke, myocardial infarction, or death did not differ significantly in the group undergoing carotid-artery stenting and the group undergoing carotid endarterectomy. During the periprocedural period, there was a higher risk of stroke with stenting and a higher risk of myocardial infarction with endarterectomy. (ClinicalTrials.gov number, NCT00004732.).

Original languageEnglish (US)
Pages (from-to)11-23
Number of pages13
JournalNew England Journal of Medicine
Volume363
Issue number1
DOIs
StatePublished - Jul 1 2010

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Endarterectomy
Carotid Stenosis
Stroke
Carotid Endarterectomy
Myocardial Infarction
Carotid Arteries
Therapeutics
Random Allocation
Cause of Death
Confidence Intervals
Incidence

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Brott, T. G., Hobson, R. W., Howard, G., Roubin, G. S., Clark, W., Brooks, W., ... Meschia, J. F. (2010). Stenting versus endarterectomy for treatment of carotid-artery stenosis. New England Journal of Medicine, 363(1), 11-23. https://doi.org/10.1056/NEJMoa0912321

Stenting versus endarterectomy for treatment of carotid-artery stenosis. / Brott, Thomas G.; Hobson, Robert W.; Howard, George; Roubin, Gary S.; Clark, Wayne; Brooks, William; Mackey, Ariane; Hill, Michael D.; Leimgruber, Pierre P.; Sheffet, Alice J.; Howard, Virginia J.; Moore, Wesley S.; Voeks, Jenifer H.; Hopkins, L. Nelson; Cutlip, Donald E.; Cohen, David J.; Popma, Jeffrey J.; Ferguson, Robert D.; Cohen, Stanley N.; Blackshear, Joseph L.; Silver, Frank L.; Mohr, J. P.; Lal, Brajesh K.; Meschia, James F.

In: New England Journal of Medicine, Vol. 363, No. 1, 01.07.2010, p. 11-23.

Research output: Contribution to journalArticle

Brott, TG, Hobson, RW, Howard, G, Roubin, GS, Clark, W, Brooks, W, Mackey, A, Hill, MD, Leimgruber, PP, Sheffet, AJ, Howard, VJ, Moore, WS, Voeks, JH, Hopkins, LN, Cutlip, DE, Cohen, DJ, Popma, JJ, Ferguson, RD, Cohen, SN, Blackshear, JL, Silver, FL, Mohr, JP, Lal, BK & Meschia, JF 2010, 'Stenting versus endarterectomy for treatment of carotid-artery stenosis', New England Journal of Medicine, vol. 363, no. 1, pp. 11-23. https://doi.org/10.1056/NEJMoa0912321
Brott, Thomas G. ; Hobson, Robert W. ; Howard, George ; Roubin, Gary S. ; Clark, Wayne ; Brooks, William ; Mackey, Ariane ; Hill, Michael D. ; Leimgruber, Pierre P. ; Sheffet, Alice J. ; Howard, Virginia J. ; Moore, Wesley S. ; Voeks, Jenifer H. ; Hopkins, L. Nelson ; Cutlip, Donald E. ; Cohen, David J. ; Popma, Jeffrey J. ; Ferguson, Robert D. ; Cohen, Stanley N. ; Blackshear, Joseph L. ; Silver, Frank L. ; Mohr, J. P. ; Lal, Brajesh K. ; Meschia, James F. / Stenting versus endarterectomy for treatment of carotid-artery stenosis. In: New England Journal of Medicine. 2010 ; Vol. 363, No. 1. pp. 11-23.
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abstract = "BACKGROUND: Carotid-artery stenting and carotid endarterectomy are both options for treating carotid-artery stenosis, an important cause of stroke. METHODS: We randomly assigned patients with symptomatic or asymptomatic carotid stenosis to undergo carotid-artery stenting or carotid endarterectomy. The primary composite end point was stroke, myocardial infarction, or death from any cause during the periprocedural period or any ipsilateral stroke within 4 years after randomization. RESULTS: For 2502 patients over a median follow-up period of 2.5 years, there was no significant difference in the estimated 4-year rates of the primary end point between the stenting group and the endarterectomy group (7.2{\%} and 6.8{\%}, respectively; hazard ratio with stenting, 1.11; 95{\%} confidence interval, 0.81 to 1.51; P = 0.51). There was no differential treatment effect with regard to the primary end point according to symptomatic status (P = 0.84) or sex (P = 0.34). The 4-year rate of stroke or death was 6.4{\%} with stenting and 4.7{\%} with endarterectomy (hazard ratio, 1.50; P = 0.03); the rates among symptomatic patients were 8.0{\%} and 6.4{\%} (hazard ratio, 1.37; P = 0.14), and the rates among asymptomatic patients were 4.5{\%} and 2.7{\%} (hazard ratio, 1.86; P = 0.07), respectively. Periprocedural rates of individual components of the end points differed between the stenting group and the endarterectomy group: for death (0.7{\%} vs. 0.3{\%}, P = 0.18), for stroke (4.1{\%} vs. 2.3{\%}, P = 0.01), and for myocardial infarction (1.1{\%} vs. 2.3{\%}, P = 0.03). After this period, the incidences of ipsilateral stroke with stenting and with endarterectomy were similarly low (2.0{\%} and 2.4{\%}, respectively; P = 0.85). CONCLUSIONS: Among patients with symptomatic or asymptomatic carotid stenosis, the risk of the composite primary outcome of stroke, myocardial infarction, or death did not differ significantly in the group undergoing carotid-artery stenting and the group undergoing carotid endarterectomy. During the periprocedural period, there was a higher risk of stroke with stenting and a higher risk of myocardial infarction with endarterectomy. (ClinicalTrials.gov number, NCT00004732.).",
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T1 - Stenting versus endarterectomy for treatment of carotid-artery stenosis

AU - Brott, Thomas G.

AU - Hobson, Robert W.

AU - Howard, George

AU - Roubin, Gary S.

AU - Clark, Wayne

AU - Brooks, William

AU - Mackey, Ariane

AU - Hill, Michael D.

AU - Leimgruber, Pierre P.

AU - Sheffet, Alice J.

AU - Howard, Virginia J.

AU - Moore, Wesley S.

AU - Voeks, Jenifer H.

AU - Hopkins, L. Nelson

AU - Cutlip, Donald E.

AU - Cohen, David J.

AU - Popma, Jeffrey J.

AU - Ferguson, Robert D.

AU - Cohen, Stanley N.

AU - Blackshear, Joseph L.

AU - Silver, Frank L.

AU - Mohr, J. P.

AU - Lal, Brajesh K.

AU - Meschia, James F.

PY - 2010/7/1

Y1 - 2010/7/1

N2 - BACKGROUND: Carotid-artery stenting and carotid endarterectomy are both options for treating carotid-artery stenosis, an important cause of stroke. METHODS: We randomly assigned patients with symptomatic or asymptomatic carotid stenosis to undergo carotid-artery stenting or carotid endarterectomy. The primary composite end point was stroke, myocardial infarction, or death from any cause during the periprocedural period or any ipsilateral stroke within 4 years after randomization. RESULTS: For 2502 patients over a median follow-up period of 2.5 years, there was no significant difference in the estimated 4-year rates of the primary end point between the stenting group and the endarterectomy group (7.2% and 6.8%, respectively; hazard ratio with stenting, 1.11; 95% confidence interval, 0.81 to 1.51; P = 0.51). There was no differential treatment effect with regard to the primary end point according to symptomatic status (P = 0.84) or sex (P = 0.34). The 4-year rate of stroke or death was 6.4% with stenting and 4.7% with endarterectomy (hazard ratio, 1.50; P = 0.03); the rates among symptomatic patients were 8.0% and 6.4% (hazard ratio, 1.37; P = 0.14), and the rates among asymptomatic patients were 4.5% and 2.7% (hazard ratio, 1.86; P = 0.07), respectively. Periprocedural rates of individual components of the end points differed between the stenting group and the endarterectomy group: for death (0.7% vs. 0.3%, P = 0.18), for stroke (4.1% vs. 2.3%, P = 0.01), and for myocardial infarction (1.1% vs. 2.3%, P = 0.03). After this period, the incidences of ipsilateral stroke with stenting and with endarterectomy were similarly low (2.0% and 2.4%, respectively; P = 0.85). CONCLUSIONS: Among patients with symptomatic or asymptomatic carotid stenosis, the risk of the composite primary outcome of stroke, myocardial infarction, or death did not differ significantly in the group undergoing carotid-artery stenting and the group undergoing carotid endarterectomy. During the periprocedural period, there was a higher risk of stroke with stenting and a higher risk of myocardial infarction with endarterectomy. (ClinicalTrials.gov number, NCT00004732.).

AB - BACKGROUND: Carotid-artery stenting and carotid endarterectomy are both options for treating carotid-artery stenosis, an important cause of stroke. METHODS: We randomly assigned patients with symptomatic or asymptomatic carotid stenosis to undergo carotid-artery stenting or carotid endarterectomy. The primary composite end point was stroke, myocardial infarction, or death from any cause during the periprocedural period or any ipsilateral stroke within 4 years after randomization. RESULTS: For 2502 patients over a median follow-up period of 2.5 years, there was no significant difference in the estimated 4-year rates of the primary end point between the stenting group and the endarterectomy group (7.2% and 6.8%, respectively; hazard ratio with stenting, 1.11; 95% confidence interval, 0.81 to 1.51; P = 0.51). There was no differential treatment effect with regard to the primary end point according to symptomatic status (P = 0.84) or sex (P = 0.34). The 4-year rate of stroke or death was 6.4% with stenting and 4.7% with endarterectomy (hazard ratio, 1.50; P = 0.03); the rates among symptomatic patients were 8.0% and 6.4% (hazard ratio, 1.37; P = 0.14), and the rates among asymptomatic patients were 4.5% and 2.7% (hazard ratio, 1.86; P = 0.07), respectively. Periprocedural rates of individual components of the end points differed between the stenting group and the endarterectomy group: for death (0.7% vs. 0.3%, P = 0.18), for stroke (4.1% vs. 2.3%, P = 0.01), and for myocardial infarction (1.1% vs. 2.3%, P = 0.03). After this period, the incidences of ipsilateral stroke with stenting and with endarterectomy were similarly low (2.0% and 2.4%, respectively; P = 0.85). CONCLUSIONS: Among patients with symptomatic or asymptomatic carotid stenosis, the risk of the composite primary outcome of stroke, myocardial infarction, or death did not differ significantly in the group undergoing carotid-artery stenting and the group undergoing carotid endarterectomy. During the periprocedural period, there was a higher risk of stroke with stenting and a higher risk of myocardial infarction with endarterectomy. (ClinicalTrials.gov number, NCT00004732.).

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