Similar Effect on Stroke Outcome Seen in Both Surgery and Stenting of Carotid Artery

Long-term effects on fatal or disabling stroke in asymptomatic patients with severe carotid artery stenosis are found to be similar in both carotid artery surgery and stenting as per a study (ACST-2 trial) presented in a Hot Line session at the European Society of Cardiology (ESC) Congress 2021 and published in the journal The Lancet.

Both carotid artery stenting (CAS) & carotid artery surgery (carotid endarterectomy - CEA) are performed in asymptomatic patients with severe carotid artery stenosis to further restore patency of the artery and reduce the long-term risk of stroke.

‘Long-term effects on fatal or disabling stroke in asymptomatic patients with severe carotid artery stenosis are found to be similar in both carotid artery surgery and stenting. ’

However, nationwide registry data from Germany shows that among asymptomatic patients, CAS and CEA are both associated with an approximately 1% risk of disabling stroke or death.

The ACST-2 trial enrolled 3,625 patients from 130 centers in 33 countries. All the patients had severe carotid artery narrowing (60% or more reduction in diameter on ultrasound) that was found by chance.

Risk of Stroke

The patients had no recent stroke or other neurological symptoms. They were followed up for an average of five years. Primarily the outcomes such as procedural risks (morbidity and mortality within one month after the procedure) and non-procedural stroke, subdivided by severity were assessed.

It was found that 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).

Almost 2.5% of patients in each group had a fatal or disabling stroke in five years. Any non-procedural stroke occurred in 5.3% of the CAS group versus 4.5% of the CEA group.

"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," says Principal investigator Professor Alison Halliday of the University of Oxford, UK.

Source: Medindia