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Stenting for Carotid Stenosis Unsafe for Older Adults

Last Updated: September 10, 2010.

Stenting for treatment of carotid stenosis should be avoided in patients 70 years of age or older, but the approach appears to be as safe as endarterectomy in patients younger than 70, according to a meta-analysis published online Sept. 10 in The Lancet.

FRIDAY, Sept. 10 (HealthDay News) -- Stenting for treatment of carotid stenosis should be avoided in patients 70 years of age or older, but the approach appears to be as safe as endarterectomy in patients younger than 70, according to a meta-analysis published online Sept. 10 in The Lancet.

Martin M. Brown, M.D., of the University College London, and colleagues pooled and assessed data on 3,433 patients with symptomatic carotid stenosis who were enrolled in the Endarterectomy versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis trial, the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) trial, and the International Carotid Stenting Study (ICSS).

The investigators found that any stroke or death occurred significantly more often in the carotid stenting group (8.9 percent) compared to the carotid endarterectomy group (5.8 percent) during the first 120 days after randomization. In patients younger than 70 years of age, the estimated 120-day risk of stroke or death was 5.8 percent in the carotid stenting group and 5.7 percent in the carotid endarterectomy group. In patients 70 years of age or older, the estimates were 12 and 5.9 percent, respectively. In patients younger than 70 years of age, risk estimates of stroke or death within 30 days of treatment were 5.1 percent in the carotid stenting group and 4.5 percent in the endarterectomy group. In patients 70 years of age or older, the estimates were 10.5 and 4.4 percent, respectively.

"Stenting for symptomatic carotid stenosis should be avoided in older patients (age ≥70 years), but might be as safe as endarterectomy in younger patients," the authors write.

The SPACE trial was funded by grants from Boston Scientific, Guidant, and Sanofi-Aventis. ICSS was funded in part by grants from Sanofi-Synthélabo.

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