The Lancet Neurology, Early Online Publication, 12 July 2013
Copyright 2013Elsevier LtdAll rights reserved.
Findings from randomised trials have shown a higher early risk of stroke after carotid artery stenting than after carotid endarterectomy. We assessed whether white-matter lesions affect the perioperative risk of stroke in patients treated with carotid artery stenting versus carotid endarterectomy.
1036 patients (536 randomly allocated to carotid artery stenting, 500 to carotid endarterectomy) had baseline imaging available. Median ARWMC score was 7, and patients were dichotomised into those with a score of 7 or more and those with a score of less than 7. In patients treated with carotid artery stenting, those with an ARWMC score of 7 or more had an increased risk of stroke compared with those with a score of less than 7 (HR for any stroke 276, 95% CI 117651; p=0021; HR for non-disabling stroke 300, 110836; p=0031), but we did not see a similar association in patients treated with carotid endarterectomy (HR for any stroke 118, 040355; p=076; HR for disabling or fatal stroke 141, 038526; p=0607). Carotid artery stenting was associated with a higher risk of stroke compared with carotid endarterectomy in patients with an ARWMC score of 7 or more (HR for any stroke 298, 129693; p=0011; HR for non-disabling stroke 634, 1452771; p=0014), but there was no risk difference in patients with an ARWMC score of less than 7.
The presence of white-matter lesions on brain imaging should be taken into account when selecting patients for carotid revascularisation. Carotid artery stenting should be avoided in patients with more extensive white-matter lesions, but might be an acceptable alternative to carotid endarterectomy in patients with less extensive lesions.
Medical Research Council, the Stroke Association, Sanofi-Synthlabo, the European Union Research Framework Programme 5.
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Effect of white-matter lesions on the risk of periprocedural stroke after carotid artery stenting versus ...