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. ISRCTN 57874028.12.
Blinded (outcome adjudication committee).*
35 centers in Germany, Austria, and Switzerland.
1214 patients > 50 years of age (mean age 68 y, 72% men) who had severe carotid artery stenosis (≥ 70% by European Carotid Surgery Trial criteria) that was symptomatic in the previous 6 months.
CAS (n = 613) or CEA (n = 601).
Primary outcome was ipsilateral stroke or death from any cause at 30 days (noninferiority). Secondary outcomes at 2 years were ipsilateral ischemic stroke (including any stroke or death within 30 d), ipsilateral disabling stroke (including disabling stroke or death within 30 d), ipsilateral ischemic stroke or vascular death, death from any cause, any stroke, and recurrent stenosis (≥ 70%).
88% (intention-to-treat analysis).
CAS was not shown to be noninferior to CEA at 30 days (Table). Groups did not differ for recurrent cerebrovascular events at 2 years (Table). Recurrent stenosis occurred more frequently in the CAS group (11% vs 4.6%, P = 0.0009).
In patients with severe symptomatic carotid stenosis, stenting and endarterectomy were similarly effective for preventing recurrent cerebrovascular events at 2 years.
Carotid artery stenting (CAS) vs carotid endarterectomy (CEA) for preventing recurrent cerebrovascular events in patients with severe symptomatic stenosis†
†Abbreviations defined in Glossary. RRI and CI calculated from hazard ratios in article.
‡The criterion for noninferiority was not met because the upper 95% confidence limit was > 2.5%.
§Including death within 30 d.
Koelemay MJ, Legemate DA. Carotid artery stenting and carotid endarterectomy were similarly effective in severe symptomatic stenosis. Ann Intern Med. ;150:JC2–11. doi: 10.7326/0003-4819-150-4-200902170-02011
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Published: Ann Intern Med. 2009;150(4):JC2-11.
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