Endarteriëctomie gunstiger dan stent bij symptomatische carotisstenose

hoger risico op CVA of overlijden na stentplaatsing
Stand van zaken
Robbert Meerwaldt, Roland J. Beuk, Ad B. Huisman, Sanne M. Manschot, Clark J. Zeebregts en Robert H. Geelkerken

Endarterectomy more favourable than stenting in symptomatic significant carotid stenosis: higher risk of ischaemic stroke or death following stenting

Conflict of interest: none declared. Financial support: none declared.

  • Carotid endarterectomy (CEA) has proven its value in the treatment of patients with recent significant carotid artery stenosis.

  • Percutaneous transluminal angioplasty with carotid artery stenting (‘stenting’ in short) is an alternative to CEA.

  • The results of stenting and CEA in patients with symptomatic significant carotid artery stenosis were evaluated in 9 prospective randomized controlled trials and 11 meta-analyses. Almost all of these trials failed to show superiority of stenting to CEA.

  • According to the 4 largest and most recent studies in this field the risk of a stroke or death within 30 days after the intervention is considerably higher following stenting than following CEA.

  • In the long run the results of stenting and CEA seem to be comparable.

  • CEA remains the gold standard in treatment of significant carotid artery stenosis, in particular in patients older than 70.