Abstract
CAS has garnered considerable enthusiasm among interventionalists and especially nonsurgical interventionalists as a “non-inferior” alternative to carotid endarterectomy (CEA). Indeed, the widely anticipated CREST trial involving both symptomatic and asymptomatic patients concluded that there were no significant differences between CAS and CEA when the composite primary outcomes of stroke, myocardial infarction, or death were measured [1]. The conclusion that CAS was non-inferior to CEA occurred only because of a higher incidence of myocardial infarction among the CAS patients, most of which were asymptomatic and were associated with cardiac biomarker abnormalities only.
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