(February 25, 2010 - Insidermedicine)

Individuals with blockages in their carotid arteries are generally better off if they undergo surgery to remove the blockage, rather than the less invasive stent implantation, according to a randomized trial published online ahead of print in The Lancet Neurology.

Here is some information about endarterectomy:

•       It is a surgical procedure in which plaque is removed from an artery that is narrowed or blocked

•       It is the standard treatment for narrowing or blockages in the carotid artery, which feeds the brain

•       In the procedure, the surgeon makes an incision in the artery and removes the plaque from its inner lining, restoring blood flow

Researchers from the National Hospital for Neurology and Neurosurgery in London randomly assigned nearly 2,000 patients with blocked or narrowed carotid arteries to treatment with endarterectomy or placement of a stent, a nonsurgical procedure in which a metal tube is inserted into the blockage to hold it open.

After a follow-up period of up to 120 days, 8.5% of the patients who received a stent experienced a stroke, compared with only 5.2% of those who underwent surgery. In total, 84 of those who received a stent had a stroke or died, compared with only 42 in the surgery group. This difference was mainly driven by an increase of non-debilitating strokes among those who received a stent, however. The rate of debilitating stroke or death was actually similar between the two groups. Among a subgroup of patients who underwent brain imaging after treatment, new cases of narrowing of the carotid arteries were seen more commonly in those who received a stent.

Today's research suggests that endarterectomy should remain the standard of care until such time as research can demonstrate that stent placement, a less invasive procedure, can produce similar or superior outcomes.