Studies show stenting as effective as surgeries

AORN Journal, July, 2008

Stenting may be as effective as two types of surgery for heart disease, according to studies published in The New England Journal of Medicine (NEJM) on April 10, and April 24, 2008. Research showed that stenting has similar long-term outcomes both to endarterectomy and coronary-artery bypass grafting (CABG).

Compared to carotid artery stenting with an emboli-protection device, there were no significant differences seen in high-risk surgical patients who underwent endarterectomy, according to a study in the April 10 NEJM. At three years, data were available for 260 of the 334 patients initially enrolled in the study, including 85.6% of the stenting group and 70% of the endarterectomy group.

Results showed that 41 patients in the stenting group experienced death, stroke, or myocardial infarction within 30 days of the procedure, compared to 45 patients in the endarterectomy group. Fifteen patients in each group experienced a stroke during the three-year follow-up period, including 11 ipsilateral strokes in the stenting group and nine in the endarterectomy group.

Stent implantation is also similar to CABG surgery for long-term outcomes, according to a study in the April 24 NEJM. Researchers from Korea reported seeing no significant difference in the rates of death, stroke, or Q-wave myocardial infarction between patients with unprotected left main coronary artery disease who underwent either treatment. Researchers evaluated 1,102 patients who received stents, including drug-eluting stents, and 1,138 patients who underwent CABG surgery between January 2000 and June 2006.

Results indicated that each group of patients was at a similar risk of death following treatment. The rates of target-vessel revascutarization were significantly higher in the stent group compared to the CABG group, however, and those patients who received drug-eluting stents trended toward a higher rate of death and complications than patients who underwent CABG.

Grum HS Yadav JS, Fayad P et al. Long-term results of carotid stenting versus endarterectomy in high-risk patients. N Engl 3 Med. 2008;358(15):1572-1579.

Seung KB, Park DW, Kim YH et al. Stents versus coronary-artery bypass grafting for left main coronary artery disease. N Engl J. Med. 2008;358(17):1781-1792.