Carotid Stenting Should Be Avoided in Older Patients

Of all subgroup variables assessed in the meta-analysis, only age significantly modified the treatment effect. While in patients younger than 70 years, the estimated 120-day risk for stroke or death was 5.8% in the carotid stenting group and 5.7% in the carotid endarterectomy group, in patients 70 years or older, the estimated risk for stroke or death was twice that with carotid endarterectomy: 12.0% versus 5.9%. The findings also suggest that stenting might be a viable alternative to endarterectomy in younger patients, although there is some uncertainty about the potentially higher rate of recurrent stenosis after stenting, and the implications this might have for future stroke risk in these patients. The study was published early online on September 10, 2010, in the Lancet.

"There is strong evidence that, in the short term, the harm of stenting compared with endarterectomy decreases with younger age,” concluded lead author Martin Brown, M.D., and colleagues of the carotid stenting trialists' collaboration. "An approach of offering stenting when technically feasible as an alternative option to endarterectomy to patients younger than 65-70 years with symptomatic carotid stenosis, in centers in which acceptable periprocedural outcomes have been independently verified, might seem justified, as long as patients are made aware of a possible increase in the risk of restenosis.”

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