The October 4, 2011 issue of the Journal of the American College of Cardiology includes a paper which suggests that while carotid stent use has clear short term benefits compared with the surgical option, these benefits were reduced at the one year time point to the extent that results were equivalent with the surgical option. As reported on heartwire (www.theheart.org) the findings are an analysis of the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST) published in the October 4, 2011 issue of the Journal of the American College of Cardiology. The study shows that stenting reduces patient pain and improves mobility at two weeks and one month, as well as having other patient benefits, but by one year any differences in health-related quality of life outcomes had disappeared between the carotid-stenting and endarterectomy study arms.
CREST was a randomized 10-year study of 2502 symptomatic and asymptomatic patients at 117 clinical sites in the US and Canada, and showed that patients treated with stenting had a similar combined rate of death, stroke, and MI as those who underwent surgery. Those who underwent surgery, however, had fewer strokes and those who had stenting fewer MIs over follow-up. Based on the results of CREST, the US Food and Drug Administration approved an expanded indication for the RX Acculink carotid stent system (Abbott Vascular, Santa Clara, CA) to include patients at standard surgical risk for carotid endarterectomy.
The heartwire article goes on to say; “The investigators assessed health-related Quality of Life indicators using the Medical Outcomes Study Short Form 36 (SF-36) and six disease-specific scales. As noted, there were differences in physical function, pain, and the physical component summary scale between the two revascularization procedures, with stenting patients experiencing less difficulty with driving, eating/swallowing, neck pain, and headaches but more difficulty with walking and more leg pain. By one year, there were no statistically significant differences in any of the QoL measurements between the two treatments.”
References: Cohen DJ, Stolker JM, Wang K, et al. Health-related quality of life after carotid stenting versus carotid endarterectomy. J Am Coll Cardiol 2011; 58: 1557-65.
Sources: American Journal of Cardiology, www.theheart.org