Abstract
The Carotid Stenosis Trialists’ Collaboration pooled data of four randomized trials that recruited patients between 2000 and 2008: Endarterectomy vs Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S), Stent-Protected Angioplasty vs Carotid Endarterectomy (SPACE), International Carotid Stenting Study (ICSS), and Carotid Revascularization Endarterectomy vs Stenting Trial (CREST). Compared with carotid endarterectomy (CEA; 2271 patients), symptomatic patients treated with carotid artery stenting (CAS; 2236) had higher stroke or death rates (4.7% vs 1.9%) the day of the procedure but not during the following 30 days (2.5% vs 2.0%). Age increased the risk of events both the day of the procedure and during follow-up for CAS. The increased procedural stroke or death risk associated with CAS compared with CEA in symptomatic patients is caused by an excess of events occurring the day of the procedure. Procedural safety of CAS needs to be enhanced by technical improvements and increased skill of the operator. Higher age increased the risk for both immediate and delayed events in CAS.
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