In the treatment of patients with symptomatic narrowing (stenosis) of the carotid artery, angioplasty with stenting and endarterectomy (surgical removal of the obstruction) are similarly effective in preventing ipsilateral stroke at two and four years after the procedure, according to two studies.

Ipsilateral stroke is a stroke that occurs on the same side as the carotid artery that has the blockage. The carotid arteries carry blood to the brain.

Currently, endarterectomy is the standard treatment for narrowing of the carotid artery. Stenting is an alternative treatment is which a rigid mesh tube is used to widen and reinforce the artery. Stenting is less invasive, but the long-term effectiveness of stenting hadn’t been investigated.

In one study, researchers compared endarterectomy and stenting in 1,214 patients in Austria, Germany, and Switzerland by measuring rates of ipsilateral stroke and restenosis (recurrence of blockage) up to two years after the procedures.

Re-blockage to at least 70 percent of the artery occurred in 10.7 percent of the patients who had stenting and in 4.6 percent of those who had surgery. Ipsilateral stroke occurred in 9.5 percent of patients who had stenting and in 8.8 percent of those who had surgery.

In the second study, researchers in France assessed 265 patients who had stenting and 262 patients who had endarterectomy. The patients were checked for a composite outcome of any stroke or death at 30 days after the procedures, and for ipsilateral stroke up to four years after the procedures.

“Although, overall, the patients who underwent stenting were twice as likely to have this composite outcome, stroke mostly occurred soon after the procedure (within 30 days), and there was no difference in the risk of ipsilateral stroke among patients who did not have a stroke within this postoperative period; therefore, stenting seems to be as effective as endarterectomy in the medium term,” said a news release about the study.

Both studies were published online and in the October issue of The Lancet Neurology.

“The results of both trials seem to recommend stenting as an alternative treatment to endarterectomy in the medium term, but the risks of stroke and death need to be reduced in the crucial 30-day period after surgery, possibly through defining better criteria to select patients,” the journal news release said.

(The Lancet Neurology, news release, Sept. 6, 2008)