Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial

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Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial

Ederle, Joerg (author)

Dobson, Joanna (author)

Featherstone, Roland L. (author)

Bonati, Leo H. (author)

van der Worp, H. Bart (author)

de Borst, Gert J. (author)

Lo, T. Hauw (author)

Gaines, Peter (author)

Dorman, Paul J. (author)

Macdonald, Sumaira (author)

Lyrer, Philippe A. (author)

Hendriks, Johanna M. (author): Karolinska Institutet

McCollum, Charles (author)

Nederkoorn, Paul J. (author)

Brown, Martin M. (author)

Algra, A. (author)

Bamford, J. (author)

Beard, J. (author)

Bland, M. (author)

Bradbury, A. W. (author)

Brown, M. M. (author)

Clifton, A. (author)

Gaines, P. (author)

Hacke, W. (author)

Halliday, A. (author)

Malik, I. (author)

Mas, J. L. (author)

McGuire, A. J. (author)

Sidhu, P. (author)

Venables, G. (author)

Bradbury, A. (author)

Brown, M. M. (author)

Clifton, A. (author)

Gaines, P. (author)

Collins, R. (author)

Molynewc, A. (author)

Naylor, R. (author)

Warlow, C. (author)

Ferro, J. M. (author)

Thomas, D. (author)

Bonati, L. H. (author)

Coward, L. (author)

Dobson, J. (author)

Ederle, J. (author)

Featherstone, R. F. (author)

Tindall, H. (author)

McCabe, D. J. H. (author): Karolinska Institutet

Wallis, A. (author)

Brooks, M. (author)

Chambers, B. (author)

Chan, A. (author)

Chu, P. (author)

Clark, D. (author)

Dewey, H. (author)

Donnan, G. (author)

Fell, G. (author)

Hoare, M. (author)

Molan, M. (author): Karolinska Institutet

Roberts, A. (author)

Roberts, N. (author)

Beiles, B. (author)

Bladin, C. (author)

Clifford, C. (author): Karolinska Institutet

Fell, G. (author)

Grigg, M. (author)

New, G. (author)

Bell, R. (author)

Bower, S. (author)

Chong, W. (author)

Holt, M. (author)

Saunder, A. (author)

Than, P. G. (author): Karolinska Institutet

Gett, S. (author)

Leggett, D. (author)

McGahan, T. (author)

Quinn, J. (author)

Ray, M. (author)

Wong, A. (author)

Woodruff, P. (author)

Foreman, R. (author)

Schultz, D. (author)

Scroop, R. (author)

Stanley, B. (author)

Allard, B. (author)

Atkinson, N. (author)

Cambell, W. (author)

Davies, S. (author)

Field, P. (author)

Milne, P. (author)

Mitchell, P. (author)

Tress, B. (author)

Yan, B. (author)

Beasley, A. (author)

Dunbabin, D. (author)

Stary, D. (author)

Walker, S. (author)

Cras, P. (author)

d'Archambeau, O. (author)

Hendriks, J. M. H. (author)

Van Schil, P. (author)

Bosiers, M. (author)

Deloose, K. (author)

van Buggenhout, E. (author)

De Letter, J. (author)

Devos, V. (author)

Ghekiere, J. (author)

Vanhooren, G. (author)

Astarci, P. (author)

Hammer, F. (author)

Lacroix, V. (author)

Peeters, A. (author)

Verhelst, R. (author)

DeJaegher, L. (author)

Peeters, A. (author)

Verbist, J. (author)

Blair, J-F (author)

Caron, J. L. (author)

Daneault, N. (author)

Giroux, M-F (author)

Guilbert, F. (author)

Lanthier, S. (author)

Lebrun, L-H (author)

Oliva, V. (author)

Raymond, J. (author)

Roy, D. (author)

Soulez, G. (author)

Weill, A. (author)

Hill, M. (author)

Hu, W. (author)

Hudion, M. (author)

Morrish, W. (author)

Sutherland, G. (author)

Wong, J. (author)

Alback, A. (author)

Harno, H. (author)

Ijas, P. (author)

Kaste, M. (author)

Lepantalo, M. (author)

Mustanoja, S. (author)

Paananen, T. (author)

Porras, M. (author)

Putaala, J. (author)

Railo, M. (author)

Sairanen, T. (author)

Soinne, L. (author)

Vehmas, A. (author)

Vikatmaa, P. (author)

Goertler, M. (author)

Halloul, Z. (author)

Skalej, M. (author)

Brennan, P. (author)

Kelly, C. (author)

Leahy, A. (author)

Moroney, J. (author)

Thornton, J. (author)

Koelemay, M. J. W. (author)

Nederkoorn, P. J. (author)

Reekers, J. A. A. (author)

Roos, Y. B. W. E. M. (author)

Hendriks, J. M. (author)

Koudstaal, P. J. (author)

Pattynama, P. M. T. (author)

van der Lugt, A. (author)

van Dijk, L. C. (author)

van Sambeek, M. R. H. M. (author)

van Urk, H. (author)

Verhagen, H. J. M. (author)

Bruininckx, C. M. A. (author)

de Bruijn, S. F. (author)

Keunen, R. (author)

Knippenberg, B. (author)

Mosch, A. (author)

Treurniet, F. (author)

van Dijk, L. (author)

van Overhagen, H. (author)

Wever, J. (author)

de Beer, F. C. (author)

van den Berg, J. S. P. (author)

van Hasselt, B. A. A. M. (author)

Zeilstra, D. J. (author)

Boiten, J. (author)

van Otterloo, J. C. A. de Mol (author)

de Vries, A. C. (author)

Nieholt, G. J. Lycklama A. (author)

van der Kallen, B. F. W. (author)

Blankensteijn, J. D. (author)

De Leeuw, F. E. (author)

Kool, L. J. Schultze (author)

van der Vliet, J. A. (author)

de Borst, G. J. (author)

de Kort, G. A. P. (author)

Kapelle, L. J. (author)

Lo, T. H. (author)

Mali, W. P. Th M. (author)

Moll, F. (author)

van der Worp, H. B. (author)

Verhagen, H. (author)

Barber, P. A. (author)

Bourchier, R. (author)

Hill, A. (author)

Holden, A. (author)

Stewart, J. (author)

Bakke, S. J. (author)

Krohg-Sorensen, K. (author)

Skjelland, M. (author)

Tennoe, B. (author)

Bialek, P. (author)

Biejat, Z. (author)

Czepiel, W. (author)

Czlonkowska, A. (author)

Dowzenko, A. (author)

Jedrzejewska, J. (author)

Kobayashi, A. (author)

Lelek, M. (author)

Polanski, J. (author)

Kirbis, J. (author)

Milosevic, Z. (author)

Zvan, B. (author)

Blasco, J. (author)

Chamorro, A. (author)

Macho, J. (author)

Obach, V. (author)

Riambau, V. (author)

San Roman, L. (author)

Branera, J. (author)

Canovas, D. (author)

Estela, Jordi (author)

Gimenez Gaibar, A. (author)

Perendreu, J. (author)

Björses, Katarina (author): Lund University,Lunds universitet,Institutionen för kliniska vetenskaper, Malmö,Medicinska fakulteten,Department of Clinical Sciences, Malmö,Faculty of Medicine

Gottsäter, Anders (author): Lund University,Lunds universitet,Institutionen för kliniska vetenskaper, Malmö,Medicinska fakulteten,Department of Clinical Sciences, Malmö,Faculty of Medicine

Ivancev, Krassi (author): Lund University,Lunds universitet,Diagnostisk radiologi, Malmö,Forskargrupper vid Lunds universitet,Radiology Diagnostics, Malmö,Lund University Research Groups

Mätzsch, Thomas (author): Lund University,Lunds universitet,Institutionen för kliniska vetenskaper, Malmö,Medicinska fakulteten,Department of Clinical Sciences, Malmö,Faculty of Medicine

Sonesson, Björn (author): Lund University,Lunds universitet,Institutionen för kliniska vetenskaper, Malmö,Medicinska fakulteten,Department of Clinical Sciences, Malmö,Faculty of Medicine

Berg, B. (author)

Delle, M. (author)

Formgren, J. (author)

Gillgren, P. (author)

Kall, T-B (author)

Konrad, P. (author)

Nyman, N. (author): Karolinska Institutet

Takolander, R. (author)

Andersson, T. (author): Karolinska Institutet

Malmstedt, J. (author)

Soderman, M. (author)

Wahlgren, C. (author)

Wahlgren, N. (author)

Binaghi, S. (author)

Hirt, L. (author)

Michel, P. (author)

Ruchat, P. (author)

Bonati, L. H. (author)

Engelter, S. T. (author)

Fluri, F. (author)

Guerke, L. (author)

Jacob, A. L. (author)

Kirsch, E. (author)

Lyrer, P. A. (author)

Radue, E-W (author)

Stierli, P. (author)

Wasner, M. (author)

Wetzel, S. (author)

Bonvin, C. (author)

Kalangos, A. (author)

Lovblad, K. (author)

Murith, N. (author)

Ruefenacht, D. (author)

Sztajzel, R. (author)

Higgins, N. (author)

Kirkpatrick, P. J. (author)

Martin, P. (author)

Adam, D. (author)

Bell, J. (author)

Bradbury, A. W. (author)

Crowe, P. (author)

Gannon, M. (author)

Henderson, M. J. (author)

Sandler, D. (author)

Shinton, R. A. (author)

Scriven, J. M. (author)

Wilmink, T. (author)

D'Souza, S. (author)

Egun, A. (author)

Guta, R. (author)

Punekar, S. (author)

Seriki, D. M. (author)

Thomson, G. (author)

Brennan, A. (author)

Enevoldson, T. P. (author)

Gilling-Smith, G. (author)

Gould, D. A. (author)

Harris, P. L. (author)

McWilliams, R. G. (author)

Nasser, H-C (author)

White, R. (author)

Prakash, K. G. (author)

Serracino-Inglott, F. (author)

Subramanian, G. (author)

Symth, J. V. (author)

Walker, M. G. (author)

Clarke, M. (author)

Davis, M. (author)

Dixit, S. A. (author)

Dolman, P. (author)

Dyker, A. (author)

Ford, G. (author)

Golkar, A. (author)

Jackson, R. (author)

Jayakrishnan, V. (author)

Lambert, D. (author)

Lees, T. (author)

Louw, S. (author)

Macdonald, S. (author)

Mendelow, A. D. (author)

Rodgers, H. (author)

Rose, J. (author)

Stansby, G. (author)

Wyatt, M. (author)

Baker, T. (author)

Baldwin, N. (author)

Jones, L. (author)

Mitchell, D. (author)

Munro, E. (author)

Thornton, M. (author)

Baker, D. (author)

Davis, N. (author)

Hamilton, G. (author)

McCabe, D. (author)

Platts, A. (author)

Tibballs, J. (author)

Beard, J. (author)

Cleveland, T. (author)

Dodd, D. (author)

Gaines, P. (author)

Lonsdale, R. (author)

Nair, R. (author)

Nassef, A. (author)

Nawaz, S. (author)

Venables, G. (author)

Belli, A. (author)

Clifton, A. (author)

Cloud, G. (author)

Halliday, A. (author)

Markus, H. (author)

McFarland, R. (author)

Morgan, R. (author)

Pereira, A. (author)

Thompson, A. (author)

Chataway, J. (author)

Cheshire, N. (author)

Gibbs, R. (author)

Hammady, M. (author)

Jenkins, M. (author)

Malik, I. (author)

Wolfe, J. (author)

Adiseshiah, M. (author)

Bishop, C. (author)

Brew, S. (author)

Brookes, J. (author)

Brown, M. M. (author)

Jaeger, R. (author)

Kitchen, N. (author)

Ashleigh, R. (author)

Butterfield, S. (author)

Gamble, G. E. (author)

McCollum, C. (author)

Nasim, A. (author)

O'Neill, P. (author)

Wong, J. (author)

Edwards, R. D. (author)

Lees, K. R. (author)

MacKay, A. J. (author)

Moss, J. (author)

Rogers, P. (author)

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2010
2010
English.
In: The Lancet. - 1474-547X. ; 375:9719, s. 985-997

Related links:: http://dx.doi.org/10...; show more...; https://lup.lub.lu.s...; https://doi.org/10.1...; http://kipublication...; show less...

Journal article (peer-reviewed)

Abstract Subject headings

Background Stents are an alternative treatment to carotid endarterectomy for symptomatic carotid stenosis, but previous trials have not established equivalent safety and efficacy. We compared the safety of carotid artery stenting with that of carotid endarterectomy. Methods The International Carotid Stenting Study (ICSS) is a multicentre, international, randomised controlled trial with blinded adjudication of outcomes. Patients with recently symptomatic carotid artery stenosis were randomly assigned in a 1:1 ratio to receive carotid artery stenting or carotid endarterectomy. Randomisation was by telephone call or fax to a central computerised service and was stratified by centre with minimisation for sex, age, contralateral occlusion, and side of the randomised artery. Patients and investigators were not masked to treatment assignment. Patients were followed up by independent clinicians not directly involved in delivering the randomised treatment. The primary outcome measure of the trial is the 3-year rate of fatal or disabling stroke in any territory, which has not been analysed yet. The main outcome measure for the interim safety analysis was the 120-day rate of stroke, death, or procedural myocardial infarction. Analysis was by intention to treat (ITT). This study is registered, number ISRCTN25337470. Findings The trial enrolled 1713 patients (stenting group, n=855; endarterectomy group, n=858). Two patients in the stenting group and one in the endarterectomy group withdrew immediately after randomisation, and were not included in the ITT analysis. Between randomisation and 120 days, there were 34 (Kaplan-Meier estimate 4.0%) events of disabling stroke or death in the stenting group compared with 27 (3.2%) events in the endarterectomy group (hazard ratio [HR] 1.28, 95% CI 0.77-2.11). The incidence of stroke, death, or procedural myocardial infarction was 8.5% in the stenting group compared with 5.2% in the endarterectomy group (72 vs 44 events; HR 1.69, 1.16-2.45, p=0.006), Risks of any stroke (65 vs 35 events; HR 1.92, 1.27-2.89) and all-cause death (19 vs seven events; HR 2.76, 1.16-6.56) were higher in the stenting group than in the endarterectomy group. Three procedural myocardial infarctions were recorded in the stenting group, all of which were fatal, compared with four, all non-fatal, in the endarterectomy group. There was one event of cranial nerve palsy in the stenting group compared with 45 in the endarterectomy group. There were also fewer haematomas of any severity in the stenting group than in the endarterectomy group (31 vs 50 events; p=0.0197). Interpretation Completion of long-term follow-up is needed to establish the efficacy of carotid artery stenting compared with endarterectomy. In the meantime, carotid endarterectomy should remain the treatment of choice for patients suitable for surgery.

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By the author/editor: Ederle, Joerg; Dobson, Joanna; Featherstone, Ro ...; Bonati, Leo H.; van der Worp, H. ...; de Borst, Gert J ...; show more...; Lo, T. Hauw; Gaines, Peter; Dorman, Paul J.; Macdonald, Sumai ...; Lyrer, Philippe ...; Hendriks, Johann ...; McCollum, Charle ...; Nederkoorn, Paul ...; Brown, Martin M.; Algra, A.; Bamford, J.; Beard, J.; Bland, M.; Bradbury, A. W.; Brown, M. M.; Clifton, A.; Gaines, P.; Hacke, W.; Halliday, A.; Malik, I.; Mas, J. L.; McGuire, A. J.; Sidhu, P.; Venables, G.; Bradbury, A.; Collins, R.; Molynewc, A.; Naylor, R.; Warlow, C.; Ferro, J. M.; Thomas, D.; Bonati, L. H.; Coward, L.; Dobson, J.; Ederle, J.; Featherstone, R. ...; Tindall, H.; McCabe, D. J. H.; Wallis, A.; Brooks, M.; Chambers, B.; Chan, A.; Chu, P.; Clark, D.; Dewey, H.; Donnan, G.; Fell, G.; Hoare, M.; Molan, M.; Roberts, A.; Roberts, N.; Beiles, B.; Bladin, C.; Clifford, C.; Grigg, M.; New, G.; Bell, R.; Bower, S.; Chong, W.; Holt, M.; Saunder, A.; Than, P. G.; Gett, S.; Leggett, D.; McGahan, T.; Quinn, J.; Ray, M.; Wong, A.; Woodruff, P.; Foreman, R.; Schultz, D.; Scroop, R.; Stanley, B.; Allard, B.; Atkinson, N.; Cambell, W.; Davies, S.; Field, P.; Milne, P.; Mitchell, P.; Tress, B.; Yan, B.; Beasley, A.; Dunbabin, D.; Stary, D.; Walker, S.; Cras, P.; d'Archambeau, O.; Hendriks, J. M. ...; Van Schil, P.; Bosiers, M.; Deloose, K.; van Buggenhout, ...; De Letter, J.; Devos, V.; Ghekiere, J.; Vanhooren, G.; Astarci, P.; Hammer, F.; Lacroix, V.; Peeters, A.; Verhelst, R.; DeJaegher, L.; Verbist, J.; Blair, J-F; Caron, J. L.; Daneault, N.; Giroux, M-F; Guilbert, F.; Lanthier, S.; Lebrun, L-H; Oliva, V.; Raymond, J.; Roy, D.; Soulez, G.; Weill, A.; Hill, M.; Hu, W.; Hudion, M.; Morrish, W.; Sutherland, G.; Wong, J.; Alback, A.; Harno, H.; Ijas, P.; Kaste, M.; Lepantalo, M.; Mustanoja, S.; Paananen, T.; Porras, M.; Putaala, J.; Railo, M.; Sairanen, T.; Soinne, L.; Vehmas, A.; Vikatmaa, P.; Goertler, M.; Halloul, Z.; Skalej, M.; Brennan, P.; Kelly, C.; Leahy, A.; Moroney, J.; Thornton, J.; Koelemay, M. J. ...; Nederkoorn, P. J ...; Reekers, J. A. A ...; Roos, Y. B. W. E ...; Hendriks, J. M.; Koudstaal, P. J.; Pattynama, P. M. ...; van der Lugt, A.; van Dijk, L. C.; van Sambeek, M. ...; van Urk, H.; Verhagen, H. J. ...; Bruininckx, C. M ...; de Bruijn, S. F.; Keunen, R.; Knippenberg, B.; Mosch, A.; Treurniet, F.; van Dijk, L.; van Overhagen, H ...; Wever, J.; de Beer, F. C.; van den Berg, J. ...; van Hasselt, B. ...; Zeilstra, D. J.; Boiten, J.; van Otterloo, J. ...; de Vries, A. C.; Nieholt, G. J. L ...; van der Kallen, ...; Blankensteijn, J ...; De Leeuw, F. E.; Kool, L. J. Schu ...; van der Vliet, J ...; de Borst, G. J.; de Kort, G. A. P ...; Kapelle, L. J.; Lo, T. H.; Mali, W. P. Th M ...; Moll, F.; van der Worp, H. ...; Verhagen, H.; Barber, P. A.; Bourchier, R.; Hill, A.; Holden, A.; Stewart, J.; Bakke, S. J.; Krohg-Sorensen, ...; Skjelland, M.; Tennoe, B.; Bialek, P.; Biejat, Z.; Czepiel, W.; Czlonkowska, A.; Dowzenko, A.; Jedrzejewska, J.; Kobayashi, A.; Lelek, M.; Polanski, J.; Kirbis, J.; Milosevic, Z.; Zvan, B.; Blasco, J.; Chamorro, A.; Macho, J.; Obach, V.; Riambau, V.; San Roman, L.; Branera, J.; Canovas, D.; Estela, Jordi; Gimenez Gaibar, ...; Perendreu, J.; Björses, Katarin ...; Gottsäter, Ander ...; Ivancev, Krassi; Mätzsch, Thomas; Sonesson, Björn; Berg, B.; Delle, M.; Formgren, J.; Gillgren, P.; Kall, T-B; Konrad, P.; Nyman, N.; Takolander, R.; Andersson, T.; Malmstedt, J.; Soderman, M.; Wahlgren, C.; Wahlgren, N.; Binaghi, S.; Hirt, L.; Michel, P.; Ruchat, P.; Engelter, S. T.; Fluri, F.; Guerke, L.; Jacob, A. L.; Kirsch, E.; Lyrer, P. A.; Radue, E-W; Stierli, P.; Wasner, M.; Wetzel, S.; Bonvin, C.; Kalangos, A.; Lovblad, K.; Murith, N.; Ruefenacht, D.; Sztajzel, R.; Higgins, N.; Kirkpatrick, P. ...; Martin, P.; Adam, D.; Bell, J.; Crowe, P.; Gannon, M.; Henderson, M. J.; Sandler, D.; Shinton, R. A.; Scriven, J. M.; Wilmink, T.; D'Souza, S.; Egun, A.; Guta, R.; Punekar, S.; Seriki, D. M.; Thomson, G.; Brennan, A.; Enevoldson, T. P ...; Gilling-Smith, G ...; Gould, D. A.; Harris, P. L.; McWilliams, R. G ...; Nasser, H-C; White, R.; Prakash, K. G.; Serracino-Inglot ...; Subramanian, G.; Symth, J. V.; Walker, M. G.; Clarke, M.; Davis, M.; Dixit, S. A.; Dolman, P.; Dyker, A.; Ford, G.; Golkar, A.; Jackson, R.; Jayakrishnan, V.; Lambert, D.; Lees, T.; Louw, S.; Macdonald, S.; Mendelow, A. D.; Rodgers, H.; Rose, J.; Stansby, G.; Wyatt, M.; Baker, T.; Baldwin, N.; Jones, L.; Mitchell, D.; Munro, E.; Thornton, M.; Baker, D.; Davis, N.; Hamilton, G.; McCabe, D.; Platts, A.; Tibballs, J.; Cleveland, T.; Dodd, D.; Lonsdale, R.; Nair, R.; Nassef, A.; Nawaz, S.; Belli, A.; Cloud, G.; Markus, H.; McFarland, R.; Morgan, R.; Pereira, A.; Thompson, A.; Chataway, J.; Cheshire, N.; Gibbs, R.; Hammady, M.; Jenkins, M.; Wolfe, J.; Adiseshiah, M.; Bishop, C.; Brew, S.; Brookes, J.; Jaeger, R.; Kitchen, N.; Ashleigh, R.; Butterfield, S.; Gamble, G. E.; McCollum, C.; Nasim, A.; O'Neill, P.; Edwards, R. D.; Lees, K. R.; MacKay, A. J.; Moss, J.; Rogers, P.; show less...

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Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial

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