Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. - Université Jean-Monnet-Saint-Étienne Accéder directement au contenu
Article Dans Une Revue New England Journal of Medicine Année : 2006

Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis.

Jean-Louis Mas
Bernard Beyssen
  • Fonction : Auteur
Thierry Moulin
Didier Leys
  • Fonction : Auteur
Jacques Watelet
  • Fonction : Auteur
Jean-François Albucher
  • Fonction : Auteur
  • PersonId : 1366738
  • IdRef : 270257136
Alain Viguier
  • Fonction : Auteur
Jean-Christophe Pillet
  • Fonction : Auteur
Pascal Favrole
  • Fonction : Auteur
Jean-Philippe Neau
  • Fonction : Auteur
Xavier Ducrocq
  • Fonction : Auteur
  • PersonId : 762030
  • IdRef : 071518347
Non Renseigné
  • Fonction : Auteur

Résumé

BACKGROUND: Carotid stenting is less invasive than endarterectomy, but it is unclear whether it is as safe in patients with symptomatic carotid-artery stenosis. METHODS: We conducted a multicenter, randomized, noninferiority trial to compare stenting with endarterectomy in patients with a symptomatic carotid stenosis of at least 60%. The primary end point was the incidence of any stroke or death within 30 days after treatment. RESULTS: The trial was stopped prematurely after the inclusion of 527 patients for reasons of both safety and futility. The 30-day incidence of any stroke or death was 3.9% after endarterectomy (95% confidence interval [CI], 2.0 to 7.2) and 9.6% after stenting (95% CI, 6.4 to 14.0); the relative risk of any stroke or death after stenting as compared with endarterectomy was 2.5 (95% CI, 1.2 to 5.1). The 30-day incidence of disabling stroke or death was 1.5% after endarterectomy (95% CI, 0.5 to 4.2) and 3.4% after stenting (95% CI, 1.7 to 6.7); the relative risk was 2.2 (95% CI, 0.7 to 7.2). At 6 months, the incidence of any stroke or death was 6.1% after endarterectomy and 11.7% after stenting (P=0.02). There were more major local complications after stenting and more systemic complications (mainly pulmonary) after endarterectomy, but the differences were not significant. Cranial-nerve injury was more common after endarterectomy than after stenting. CONCLUSIONS: In this study of patients with symptomatic carotid stenosis of 60% or more, the rates of death and stroke at 1 and 6 months were lower with endarterectomy than with stenting. (ClinicalTrials.gov number, NCT00190398 [ClinicalTrials.gov].).

Dates et versions

ujm-00440338 , version 1 (10-12-2009)

Identifiants

Citer

Jean-Louis Mas, Gilles Chatellier, Bernard Beyssen, Alain Branchereau, Thierry Moulin, et al.. Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis.. New England Journal of Medicine, 2006, 355 (16), pp.1660-71. ⟨10.1056/NEJMoa061752⟩. ⟨ujm-00440338⟩
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