A new study shows that for patients with symptomatic carotid stenosis, endarterectomy has the greatest benefit among those treated within seven days of the most recent event.

Researchers at Innsbruck Medical University (Austria) performed a meta-analysis of three large randomized European trials that compared stenting versus endarterectomy surgery for symptomatic carotid stenosis. The analysis included 2,839 patients (mean age 70; 72% male). Of these, 9% were treated within 7 days of their event, 16% were treated 8 to 14 days after their event, and 76% were treated beyond 14 days.

The results showed that the rate of any stroke or death within 30 days of the procedure was significantly higher for stenting (7.7%) than for surgery (3.8%), regardless of the time since the latest event. The difference declined for those treated 8 to 14 days after their event, and beyond 14 days. Further adjustment for age, sex, and type of qualifying event attenuated the risk ratios, but there was still a significantly higher rate associated with stenting among those treated within 7 days. Similar trends were seen for the composite of disabling stroke and death, although the individual risk ratios were not statistically significant. The study was presented at the annual meeting of the Society for Vascular Surgery (SVS), held during June 2012 in National Harbor (MD, USA).

“With those results, you should avoid applying carotid artery stenting to your symptomatic patients when they're treated early,” said lead author and study presenter Gustav Fraedrich, MD. “And they should be treated early.”

Endarterectomy is a surgical procedure to remove the atheromatous plaque material, or blockage, in the lining of an artery. The procedure is widely used on the carotid artery of the neck as a way to reduce the risk of stroke, particularly when the carotid artery is narrowed by more than 70%; however, a carotid endarterectomy may itself cause a stroke at the time of operation.

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