A meta-analysis from London suggests that stroke patients over 70 years of age who undergo carotid stenting may have a double risk of new stroke or death after the procedure compared with those who undergo carotid endarterectomy. The researchers conducted a meta-analysis of three previous large-scale randomized controlled studies (EVA-3S, SPACE, ICSS) of 3433 stroke patients, 1725 of whom underwent stenting and 1708 of whom underwent carotid endarterectomy, and showed that differences in patient age led to significant differences in the long-term outcomes of stenting. For patients over 70 years of age, 12% of those who underwent stenting had a new stroke or died within 4 months of the procedure, compared with 6% of those who underwent carotid endarterectomy. For patients under 70 years of age, there was no significant difference in the incidence of new stroke or death after surgery between the two groups, and the incidence of adverse events was about 6% in both groups. The study was funded by the British Stroke Association and published in the prestigious journal Lancet on September 10, 2010. The researchers concluded that the higher risk of stenting in older patients may be due to the fact that the carotid arteries in these patients are more likely to be damaged during the procedure. The study’s presenter, Martin Brown, professor of neurology at University College London, believes the study provides evidence for the choice of procedure for non-senior patients. Tonny Rudd of the Guy’s & St. Thomas Foundation at the Royal College London said, “There is no significant difference in cost between the two procedures in the UK, but most clinicians from Europe have not been rash in performing carotid stenting on a large scale. This study reinforces our belief that carotid stenting is still a risky procedure for some patients,” he said. In February, a study from the United States also found that the overall safety of stenting and endarterectomy was comparable in patients with carotid artery stenosis. However, for patients over the age of 70, there may be a greater risk of stenting. Commenting on the study, Dr. Helmi Lutsep, associate director of the Oregon Health Sciences University and Oregon Stroke Center, said, “This study makes us realize that stenting is comparable to conventional surgery in terms of safety, but we need to remain cautious about performing carotid stenting on a large scale. In addition, the study provides good evidence to support how to select the appropriate population for stenting. In terms of procedure, however, stenting requires only a femoral artery puncture, cannulation to the carotid stenosis, balloon dilation of the lesion and placement of a stent to maintain patency of the diseased artery, and recovery from the procedure within a few days. Carotid endarterectomy, on the other hand, usually requires a general anesthetic followed by a carotid incision to remove the endothelium or the diseased artery at the site of obstruction, and often requires more than one week for recovery.