Related Experiment Video
Updated: Jun 17, 2026
A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Carotid artery stenting: a systematic review of randomized clinical trials
1Ev. Bethesda-Johanniter-Klinikum Duisburg, Germany. knur@johanniter-rheinhausen.de
Insights
Carotid artery stenting (CAS) shows promise for high-risk patients, but its effectiveness for low-risk and asymptomatic individuals requires further study. More randomized trials are needed to confirm CAS as a safe alternative to carotid surgery.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Vascular Surgery
Background:
- Carotid occlusive disease contributes significantly to major adverse cardiovascular events.
- Carotid surgery (endarterectomy) is the established treatment for extracranial carotid occlusive disease.
- Less invasive carotid artery stenting (CAS) is an emerging alternative.
Purpose of the Study:
- To review current data from randomized trials comparing CAS and carotid endarterectomy (CEA).
- To assess the evidence for CAS as a therapeutic alternative to CEA.
- To determine the current evidence base for CAS in different patient risk groups.
Main Methods:
- Review of randomized clinical trials comparing carotid artery stenting (CAS) with carotid endarterectomy (CEA).
- Analysis of data from trials such as SAPPHIRE (Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy).
- Evaluation of outcomes in high-risk, low-risk, and asymptomatic patients.
Main Results:
- The SAPPHIRE trial indicated stenting was superior to surgery in high-risk patients.
- The effectiveness of CAS in preventing stroke for low-risk and asymptomatic patients remains uncertain.
- Evidence for CAS as a definitive alternative to CEA in all patient groups is still developing.
Conclusions:
- Carotid artery stenting shows potential, particularly for high-risk patients.
- Further randomized trials are essential to establish CAS as a scientifically sound alternative to carotid surgery for low-risk and asymptomatic patients.
- Current evidence does not fully support CAS as a replacement for CEA in all patient populations.
Abstract:
Carotid occlusive disease is responsible for a significant proportion of major adverse cardiovascular events (death, stroke, myocardial infarction). Effective prevention by means of revascularization is a sufficient treatment, if performed at a center with an acceptably low procedural complication rate. Carotid surgery is the currently accepted standard of treatment for revascularization of extra cranial carotid occlusive disease. This has been validated by randomized clinical trials that have demonstrated its efficacy over best medical therapy. However, less invasive protected carotid artery stenting (CAS) has emerged as a potential therapeutic alternative to carotid endarterectomy (CEA) for the treatment of carotid atherosclerotic disease. Over the past decade several clinical trials have compared endovascular with surgical treatment. The Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) trial favored stenting over surgery in high-risk patients. The effectiveness of endovascular treatment in low-risk patients and patients with asymptomatic stenoses at preventing of stroke is still uncertain. Carotid artery stenting with an embolic protection device cannot be considered a scientifically sound and evidence-based alternative to carotid surgery in low-risk and asymptomatic patients until we have the results of further randomized trials. This overview presents the currently available data from randomized trials.
