Addition of Stenting Beneficial in Asymptomatic High-Grade Carotid Stenosis

TUESDAY, Dec. 2, 2025 (HealthDay News) -- For patients with high-grade carotid stenosis without recent symptoms, the addition of stenting is associated with a reduced risk for a composite of perioperative stroke or death or ipsilateral stroke within four years compared with medical therapy alone, while no significant benefits are seen for carotid endarterectomy, according to a study published online Nov. 21 in the New England Journal of Medicine.Thomas G. Brott, M.D. from the Mayo Clinic in Jacksonville, Florida, and colleagues conducted two clinical trials enrolling patients with high-grade (≥70 percent) asymptomatic carotid stenosis across 155 centers in five countries. The stenting trial, which included 1,245 patients, compared intensive medical management alone versus carotid-artery stenting plus intensive medical management. The endarterectomy trial, which included 1,240 patients, compared intensive medical management alone versus carotid endarterectomy plus intensive medical management.The researchers found that the four-year incidence of primary outcome events was 6.0 and 2.8 percent in the medical therapy and stenting groups, respectively, in the stenting trial (P = 0.02 for the absolute difference), and 5.3 and 3.7 percent in the medical therapy and endarterectomy groups, respectively, in the endarterectomy trial (P = 0.24 for the absolute difference). In the stenting trial, there were no strokes or deaths in the medical therapy group and seven strokes and one death in the stenting group from days 0 to 44; three strokes occurred in the medical-therapy group and nine strokes occurred in the endarterectomy group in the endarterectomy trial."Medical therapy has improved so much that we needed to reexamine the balance between benefit and risk for people who have no symptoms," Brott said in a statement.Several authors disclosed ties to the biopharmaceutical industry.Abstract/Full Text (subscription or payment may be required)Editorial (subscription or payment may be required).Sign up for our weekly HealthDay newsletter

Addition of Stenting Beneficial in Asymptomatic High-Grade Carotid Stenosis

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