SCAI: Post-stenting angioplasty reduces restenosis risk

A CREST substudy found that performing balloon angioplasty after carotid artery stenting reduced the risk of restenosis by 64 percent but increased the risk of stroke. The stroke finding was not statistically significant, though. Results were presented May 9 at the Society of Cardiovascular Angiography and Interventions (SCAI) scientific sessions in Orlando, Fla.

CREST (Carotid Revascularization Endarterectomy vs. Stenting Trial) compared carotid artery stenting with carotid endarterectomy in patients with symptomatic or asymptomatic extracranial carotid stenosis (N Engl J Med 2010;363[1]:11-23). The randomized, controlled clinical trial enrolled 2,502 patients with symptomatic or asymptomatic carotid stenosis to undergo carotid artery stenting or carotid endarterectomy.

At four years, the rate of stroke or death was 6.4 percent in the carotid artery stenting group vs. 4.7 percent in the endarterectomy group. The periprocedural risk was higher in the stenting group for stroke but lower for MI.

The CREST substudy focused on 1,113 carotid artery stenting procedures performed in the trial to retrospectively compare the risk of stroke and two-year restenosis in patients who received post-stent deployment angioplasty only (344 patients) or pre-stent deployment angioplasty only (69 patients). Mahmoud B. Malas, MD, chief of endovascular surgery at Johns Hopkins Bayview Medical Center in Baltimore, presented the results at a late-breaking clinical trial session.

The two-year risk of restenosis was 10.3 percent in the pre-stent deployment angioplasty group vs. 3.7 percent in the post-stent deployment angioplasty group. There was one periprocedural stroke in the pre-stent deployment angioplasty group and 19 in the post-stent deployment angioplasty group.

Overall, there were only 52 strokes in CREST’s carotid artery stenting group. While Malas et al noted an increased risk for stroke in the post-stent deployment angioplasty group compared with the pre-stent deployment angioplasty group, it was not statistically significant.

“We actually had too few complications to make any statistically significant assessments about risk of stroke between the different ballooning methods,” Malas said in a release.

For more on carotid artery stenting, please read “Carotid Stenting: Where Science & Policy Diverge” in Cardiovascular Business.