Abstract
To the Editor: We read with interest the article by Qureshi,1 about carotid angioplasty and stenting (CAS) after the EVA3S trial.2 The author considers that the results of EVA3S are somewhat contradictory to the existing data derived from other studies. To reach this conclusion, Dr Qureshi put together studies that are hardly comparable because of their design (randomized clinical trials (RCTs) versus registries) or the type of patients included (symptomatic versus asymptomatic stenosis, good versus poor candidates for surgery). As clearly shown by landmark RCTs of carotid surgery, natural history on medical treatment and operative risk differ largely between symptomatic and asymptomatic patients. If we focus on RCTs in symptomatic patients, SPACE3 is the only contemporary trial that can be compared with EVA3S.2 Both studies show similar results regarding the 30-day rate of stroke or death with CAS: 7.7% (95% CI: 5.7% to 10.1%) in SPACE3 compared with 9.6% (95% CI: 6.3% to 13.8%) in EVA3S,2 with a large overlap between confidence intervals. The 30-day rate of severe events …
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