Weighing Procedures for Clogged Arteries

Stroke risk may rise in older patients who have stenting but mortality risk is higher with endarterectomy

(RxWiki News) Stenting is a common procedure to treat blocked arteries. While the benefits may outweigh possible complications, stenting still poses risks, including a higher chance of stroke in older patients.

During carotid artery stenting (CAS), a surgeon places a stent (mesh tube) in one of the arteries that supplies blood flow to the brain.

While CAS may help prevent a stroke, a new study found that elderly patients who had CAS were more likely to have a stroke than younger patients who had the procedure.

An alternative option, which removes plaque from the arteries, was linked to a lower risk for stroke but may pose a greater threat to overall survival.

"Discuss all your surgical options with your doctor."

George A. Antoniou, MD, from the Department of Vascular Surgery at the Hellenic Red Cross Hospital in Athens, Greece, and fellow scientists analyzed results from 44 observational studies representing 75,201 CAS procedures and 512,685 carotid endarterectomy operations.

Carotid endarterectomy is a procedure used to remove plaque from an artery.

To evaluate interventions in the elderly, Dr. Antoniou and colleagues evaluated the results of patients age 65 and older.

The researchers discovered that elderly patients with carotid stenting were 56 percent more likely to have a stroke than their younger counterparts.

Among patients who had carotid endarterectomy, however, the risk of stroke or transient ischemic attack was the same for young and old.

On the other hand, results regarding overall survival favored stenting. Young and old stenting patients faced similar odds of dying, but older endarterectomy patients had 62 percent greater chance of dying than their younger counterparts. 

Both endarterectomy and stenting patients had 64 percent higher odds of having a heart attack compared to younger patients who had the same procedures.

Ultimately, the researchers noted that there seem to be risks involved with both procedures, but they stressed that “...age should be considered when planning a carotid intervention.”

According to the authors, “Direct comparisons of the outcomes of carotid artery stenting and carotid endarterectomy in elderly patients should be the subject of future research, including well-conducted randomized trials, if solid conclusions of the comparative efficacy of these treatments in this age group are to be reached."

In a related commentary, R. Clement Darling III, MD, of the Vascular Group in Albany, NY, responded that, based on this study, it is difficult to decide which intervention would be best for older patients, although his conclusion appeared to favor carotid endarterectomy for elderly patients.

“The bottom line is, carotid endarterectomy and carotid artery stenting seem to work equally well in younger patients, in expert hands,” he wrote. “However, in the ‘elderly’ (at any age), carotid endarterectomy has better outcomes with low morbidity, mortality and stroke rate and remains the gold standard.”

The study was published Online First by JAMA Surgery on October 23.

Review Date: 
October 23, 2013