Mark J.W. Koelemay, MD; Dink A. Legemate, MD
In patients with severe symptomatic carotid stenosis, what is the relative effectiveness of carotid artery stenting (CAS) and carotid endarterectomy (CEA) for preventing recurrent cerebrovascular events?
Randomized controlled trial. ClinicalTrials.gov NCT00190398.
Blinded (outcome adjudication committee).*
30 centers in France.
527 patients ≥ 18 years of age (mean age 70 y, 75% men) who had severe carotid artery stenosis (≥ 60% by North American Symptomatic CEA Trial criteria) that was symptomatic in the previous 120 days.
CAS (n = 265) or CEA (n = 262).
Primary outcome was any stroke or death at 30 days (noninferiority). Secondary outcomes at 4 years were any ipsilateral stroke, ipsilateral disabling stroke, any stroke, disabling stroke, any stroke or death, and disabling stroke or death (all including any stroke or death within 30 d).
99% (intention-to-treat analysis).
CAS was shown to be inferior to CEA at 30 days (Table). At 4 years, cumulative event rates were higher in the CAS group than in the CEA group for ipsilateral stroke and any stroke (Table).
In patients with severe symptomatic carotid stenosis, stenting did not prevent stroke at 4 years as effectively as endarterectomy, mainly because of higher periprocedural risk.
Carotid artery stenting (CAS) vs carotid endarterectomy (CEA) for preventing recurrent cerebrovascular events in patients with severe symptomatic stenosis†
†Abbreviations defined in Glossary. RRI, NNH, and CI calculated from data or hazard ratios in article.
‡All outcomes include any stroke or death within 30 d.
Koelemay MJ, Legemate DA. Carotid artery stenting increased risk for stroke more than carotid endarterectomy in severe symptomatic stenosis. Ann Intern Med. 2009;150:JC2–10. doi: 10.7326/0003-4819-150-4-200902170-02010
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Published: Ann Intern Med. 2009;150(4):JC2-10.
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