uu.seUppsala University Publications
Change search
ReferencesLink to record
Permanent link

Direct link
Symtomgivande karotisstenos bör opereras, inte behandlas med stent: Stent ger för stora risker, enligt studier
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery. (Vascular Surgery)
2007 (Swedish)In: Läkartidningen, ISSN 0023-7205, Vol. 104, no 6, 412-414 p.Article in journal (Refereed) Published
Abstract [en]

[Symptomatic carotid stenosis should be treated surgically, not with stenting. Great risks with stents, according to studies]

The benefit of addition carotid endarterectomy to best medical treatment for stroke prevention has been proven for both symptomatic and asymptomatic severe carotid stenosis. During recent years endovascular treatment of carotid stenosis has grown. A meta analysis of five trials published 2005 concluded that carotid artery stenting should only be done within the framework of ongoing studies and that the evidence base was lacking to change routine treatment from carotid endarterectomy to carotid artery stenting. Recently two large studies, stent supported percutaneous angioplasty of the carotid artery versus endarterectomy (SPACE) and endarterectomy versus angioplasty in patients with symptomatic severe carotid stenosis (EVA-3S) have been published. Both studies tested the hypothesis of non-inferiority of carotid artery stenting compared to carotid endarterectomy. EVA-3S was terminated prematurely because of significantly inferior results for carotid stenting, both at 30 days and 6 months. The combined incidence of stroke or death was 9.6 % in the stented group and 3.9 in the operated group and 6.1 % and 11.7 % respectively at 6 months. All differences were highly significant. In the SPACE trial non-inferiority could not be shown. Based on intention to treat no significant difference in outcome for the primary end point, ipsilateral ischaemic stroke or death within 30 days could be shown. Analyses per protocol, however, revealed a significant difference for ipsilateral stroke at 30 days, 6.95 % versus 5.64 % in the stented and the operated group respectively. SPACE did not report any long term results. Based on available evidence it is concluded that carotid artery stenting should not be performed outside ongoing randomised trials.

Abstract [sv]

Den strokeförebyggande effekten av operation (endarterektomi) för symtomgivande tät stenos av arteria carotis interna har visats i stora randomiserade studier.

Ett antal små randomiserade studier har till nyligen genomförts för att utvärdera endovaskulär behandling (angioplastik) av karotisstenos. Studierna har i många fall inkluderat patienter både med och utan symtomgivande karotisstenos behandlade med angioplastik med eller utan stent.

Nyligen har två stora multicenterstudier publicerats, en fransk och en tysk, som randomiserade patienter med symtomgivande karotisstenos till endovaskulär behandling eller öppen kirurgi med endarterektomi.

Målsättningen för bägge studierna var att testa att stentbehandling inte var underlägsen karotisendarterektomi


Bägge studierna visade att stentbehandling inte är överlägsen karotisendarterektomi och att stentbehandling sannolikt är associerad med högre risk för komplikationer än endarterektomi hos patienter med symtomgivande karotisstenos.

Baserat på dessa resultat finner vi att fortsatt behandling med stent i Sverige endast bör genomföras inom ramen för befintliga randomiserade studier.

Place, publisher, year, edition, pages
2007. Vol. 104, no 6, 412-414 p.
Keyword [en]
Angioplasty, Transluminal, Percutaneous Coronary, Carotid Stenosis/complications/*surgery, Cerebrovascular Accident/prevention & control, Endarterectomy, Carotid/adverse effects, Evidence-Based Medicine, Humans, Meta-Analysis, Randomized Controlled Trials, Risk Factors, Stents/adverse effects, Treatment Outcome
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-10981PubMedID: 17373287OAI: oai:DiVA.org:uu-10981DiVA: diva2:38749
Available from: 2007-05-08 Created: 2007-05-08 Last updated: 2010-03-24Bibliographically approved

Open Access in DiVA

No full text

Other links


Search in DiVA

By author/editor
Bergqvist, David
By organisation
Vascular Surgery
In the same journal
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 192 hits
ReferencesLink to record
Permanent link

Direct link