The dangers of carotid stenting

I wrote not so long ago, about the inferior results of Carotid Stenting when compared to surgical carotid endarterectomy. This was the SPACE study. The latest issue of the New England Journal of Medicine (19th Oct 2006), carried another study, the EVA-3S, which again compared the results of carotid stenting with surgical carotid endarterectomy. Again, the study showed that carotid stenting was inferior to carotid endarterectomy, resulting in more deaths and strokes 1 month and 6 months after the procedure.

What is upsetting is that many centers are still doing carotid stenting, instead of refering them for surgical endarterectomy, despite evidence from two studies that we now have. I wonder whether the unsuspecting patients have been properly adviced. One of the problems with interventional neuro-radiology, almost like interventional cardiology, is that the investigating radiologist is also the interventional neuro-radiologist, so he/she is the judge, jury and sometimes, executioner.

The patient, unless they are well educated, never gets to have a second opinion from an independent neurologist. I wonder how many deaths and strokes have occurred to those unsuspecting patients. I hope that interventional neuro-radiologist are not doing their equivalent of "stenting for bread".