Avoid Stenting for Carotid Stenosis in Those 70 and Older, Meta-Analysis Suggests

Stenting in patients with symptomatic carotid stenosis should be avoided in those aged 70 and older, according to a Lancet meta-analysis.


Investigators from three randomized trials, seeking to reconcile disparate findings on the risks of treatment with endarterectomy versus stenting, undertook a preplanned meta-analysis of their data. Their trials comprised some 3400 patients with symptomatic stenosis who were judged to be at standard surgical risk.


In both the intention-to-treat group (analyzed at 120 days) and per-protocol group (analyzed at 30 days), patients under age 70 showed no difference in risk for the primary outcome (the combination of any stroke or death), regardless of the therapy. In those 70 and older, however, stenting was associated with a doubling of risk.


The authors conclude their findings provide "strong evidence that, in the short term, the harm of stenting compared with endarterectomy decreases with younger age."