TDNet Discover

Background: Carotid artery stenosis is a major cause of cerebrovascular accidents (CVA) in adults. Carotid artery stenting (CAS) and carotid endarterectomy (CEA) are two accepted techniques in the treatment of carotid stenosis, but the advantages of either procedure over the other in regards to morbidity and mortality remain unclear. Objective: Comparing CEA and CAS to determine which technique yields a lower long-term mortality/morbidity. Methods: Database searches were made on PubMed, Discover Search, and MEDLINE Complete to identify major trials directly comparing CAS and CEA performed in the past ten years. The identified studies were then independently assessed against inclusion and exclusion criteria. Results: In the periprocedural period CEA yields a lower rate of CVA and death but appears to have higher rates of MI when compared with CAS. However, when analyzing data extending beyond this period, statistically significant differences were not identified in rates of primary end points between the two procedures. Conclusion: No significant differences were identified when comparing long-term morbidity/mortality rate between endarterectomy and carotid stenting. Data supports the use of CEA over CAS in symptomatic patients and those over 70 years old if the primary concern surrounding the procedure is CVA or death periprocedurally. This recommendation must be weighed against individual patient risk factors and should be analyzed in concert with other relevant data.