{"id":3176,"date":"2010-09-10T07:56:25","date_gmt":"2010-09-10T11:56:25","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?p=3176"},"modified":"2011-07-19T17:44:50","modified_gmt":"2011-07-19T21:44:50","slug":"meta-analysis-finds-high-risk-for-carotid-stenting-in-older-patients","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2010\/09\/10\/meta-analysis-finds-high-risk-for-carotid-stenting-in-older-patients\/","title":{"rendered":"Meta-Analysis Finds High Risk for Carotid Stenting in Older Patients"},"content":{"rendered":"<p>Carotid stenting should not be performed in patients age 70 years or older, according to the results of\u00a0<a href=\"http:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736(10)61009-4\/fulltext?_eventId=login\">a new meta-analysis appearing in the\u00a0<em>Lancet<\/em>.<\/a> Researchers in the Carotid Stenting Trialists\u2019 Collaboration combined data from 3433 patients with symptomatic carotid stenosis who were randomized to either endarterectomy or stenting in the EVA-3S, SPACE, and ICSS trials.<\/p>\n<p>At 120 days after randomization, the rate of stroke or death was higher in the stenting group than in the endarterectomy group (8.9% versus 5.8%, RR 1.53, p=0.0006). However, there was no difference between the groups among patients younger than age 70, while in patients age 70 or older, stenting was associated with double the risk associated with endarterectomy:<\/p>\n<ul>\n<li>Younger than age 70, stenting versus endarterectomy: 5.8% versus 5.7%<\/li>\n<li>Age 70 or older, stenting versus endarterectomy: 12% versus 5.9%, RR 2.04, p=0.0014<\/li>\n<\/ul>\n<p>A similar pattern was observed in a per-protocol analysis after 30 days restricted to patients who received the allocated treatment:<\/p>\n<ul>\n<li>Younger than age 70, stenting versus endarterectomy: 5.1% versus 4.5%<\/li>\n<li>Age 70 or older, stenting versus endarterectomy: 10.5% versus 4.4%<\/li>\n<\/ul>\n<p>The authors write that their \u201cfindings suggest that stenting might\u2026 be a viable alternative to endarterectomy in younger patients, in whom surgery could otherwise be undertaken without increased risk,\u201d although they express concern about the long-term stroke risk in young patients treated with stents due to \u201cthe potentially higher rate of recurrent stenosis after stenting than with endarterectomy.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Carotid stenting should not be performed in patients age 70 years or older, according to the results of\u00a0a new meta-analysis appearing in the\u00a0Lancet. Researchers in the Carotid Stenting Trialists\u2019 Collaboration combined data from 3433 patients with symptomatic carotid stenosis who were randomized to either endarterectomy or stenting in the EVA-3S, SPACE, and ICSS trials. At [&hellip;]<\/p>\n","protected":false},"author":196,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[20,9],"tags":[390,389],"class_list":["post-3176","post","type-post","status-publish","format-standard","hentry","category-cardiac-surgery","category-interventional-cardiology","tag-carotid-stenting","tag-endarterectomy"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/3176","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/196"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=3176"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/3176\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=3176"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=3176"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=3176"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}