Abstract
A pooled analysis was conducted of four randomized controlled trials with patients randomly assigned between November 2000 and July 2008. Review of the four largest randomized trials (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 versus Stenting Trial [CREST]) of carotid artery stenting and carotid endarterectomy (CEA) for treatment of symptomatic carotid stenosis included 4754 patients for analysis. Median follow-up ranged from 2.0 to 6.9 years. After the periprocedural period, annual rates of ipsilateral stroke per person-year were similar between the two treatments. However, the periprocedural and postprocedural stroke risks combined favored CEA with treatment differences equal to 3.2% up to 9 years. Although long-term outcomes continue to favor CEA, the similarity of postprocedural rates suggests that improvements in the periprocedural safety of carotid artery stenting could provide similar outcomes of the two procedures in the future.
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