Carotid artery stenting vs. endarterectomy

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Neurology

Background:

• Carotid endarterectomy (CEA) is proven for stroke prevention in carotid artery stenosis.
• Registry data suggest higher adverse event rates for CEA than clinical trials indicate.
• Carotid artery stenting (CAS) offers a less invasive alternative to CEA.

Purpose of the Study:

• To compare the efficacy and safety of CAS versus CEA for stroke prevention.
• To analyze data from randomized trials and large-scale registries.

Main Methods:

• Meta-analysis of 10 randomized trials involving 4648 patients comparing CAS and CEA.
• Review of large-scale CAS registries with over 20,000 patients.
• Focus on 30-day and long-term outcomes, including death and stroke rates.

Main Results:

• CAS demonstrated a statistically significant increase in 30-day death or stroke compared to CEA (OR 1.60).
• Many early trials lacked sufficient endovascular expertise and emboli protection mandates.
• Long-term follow-up suggests equivalent stroke prevention between CAS and CEA.
• High-quality CAS registries report outcomes comparable to CEA, even in high-risk surgical patients.

Conclusions:

• CAS is associated with higher early risks, potentially due to trial limitations.
• Long-term stroke prevention appears equivalent between CAS and CEA.
• CAS should be reserved for specialized centers and high-risk surgical candidates pending further data.