Stenting has been found to be as effective as carotid endarterectomy for long-term prevention of fatal and disabling strokes in patients with carotid artery disease, according to the results of an international, multicenter, randomized clinical trial reported in The Lancet.

As an invasive surgical procedure, endarterectomy leaves a scar on the neck and can lead to heart attack, short-term facial paralysis from nerve damage, and bleeding. Stenting, in a less-invasive alternative procedure, causes only minor bruising in the groin, which is the point of entry for the small mesh cylinder used to keep the artery open. Stenting carries no risk of nerve damage and is associated with a lower risk for heart attack than is endarterectomy.

Leo H. Bonati, MD, and fellow investigators in the International Carotid Stenting Study followed 1,713 persons older than age 40 years with symptomatic atherosclerotic carotid stenosis. These patients, from 50 centers in Europe, Australia, New Zealand, and Canada, were randomly assigned to stenting (855 participants) or endarterectomy (858 participants). 

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No significant differences existed in the number of fatal or disabling strokes or in cumulative 5-year risk between the 2 groups. The risk of any stroke in 5 years was higher in the stenting group (15.2% vs. 9.4%), but these were minor strokes without long-term effects.