Carotid And Vertebral Artery Transluminal Angioplasty Study Research Articles

Stenting Versus Aggressive Medical Management for Symptomatic Vertebral Artery Stenosis

Posterior circulation strokes account for 20% of all strokes (2). Traditional studies cite a 5-year stroke rate ranging from 22%e 35% following an initial vertebrobasilar transient ischemic attack (TIA) or stroke (11, 14). Contrary to traditional beliefs, the overall risk of recurrent stroke in the posterior circulation is similar to the risk after an anterior circulation stroke, and likely higher in the acute phase (8). In one pooled analysis of 359 patients experiencing vertebrobasilar territory TIA or stroke, the 90-day risk of stroke after the presenting event was 9.6% in patients with vertebrobasilar stenosis versus 2.8% in those without (OR 3.7, 95% CI 1.2e11.0, P 1⁄4 0.012) (9). The authors noted a trend that this risk was higher with intracranial vertebrobasilar stenosis than extracranial vertebral stenosis (P 1⁄4 0.06). To mitigate this risk, aggressive medical management incorporating diet and lifestyle modification, control of hypertension, and the usage of statins and antiplatelet agents may be used (3, 5, 16). In addition, multiple individual case series have suggested that stenting vertebrobasilar lesions may be associated with a low-risk profile and subsequently low rates of referable TIAs or strokes (1, 10, 12, 13, 15). A systematic review of stenting symptomatic, atherosclerotic vertebrobasilar disease reported periprocedural TIA, stroke, and death rates of 1.6%, 1.3%, and 0.3%, respectively, across 313 cases with proximal vertebral artery disease (6). Over a mean follow-up period of 14.2 months, the post-treatment annual rate of TIA or stroke in the vertebrobasilar territory was 0.6%. Interestingly, for 283 cases of distal vertebrobasilar stenting, the periprocedural TIA, stroke, and death rates were 0.7%, 10.6% and 3.2%, respectively (6). The annual rate of subsequent vertebrobasilar stroke over a mean follow-up of 13 months after treatment was 1.9%. Thus although patients with symptomatic intracranial vertebrobasilar stenosis may have a greater risk of TIA or stroke without treatment (9), the risk of stenting may also be higher in this group (6). However, more specifically, a subgroup analysis from the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial demonstrated significantly higher periprocedural ischemic events in patients undergoing stenting of the basilar artery as compared with those undergoing stenting of the intracranial internal carotid, middle cerebral, or vertebral artery (7). Before the Vertebral Artery Stenting Trial (VAST) (3), subgroup analyses of 2 randomized control trials comparing stenting of symptomatic arterial stenosis to best medical management demonstrated no benefit of stenting for patients with vertebral artery stenosis (4, 5). In the Carotid And Vertebral Artery Transluminal Angioplasty Study (CAVATAS), 16 patients with

Length of Carotid Stenosis Predicts Peri-Procedural Stroke or Death and Restenosis in Patients Randomized to Endovascular Treatment or Endarterectomy

BackgroundThe anatomy of carotid stenosis may influence the outcome of endovascular treatment or carotid endarterectomy. Whether anatomy favors one treatment over the other in terms of safety or efficacy has not been investigated in randomized trials.MethodsIn 414 patients with mostly symptomatic carotid stenosis randomized to endovascular treatment (angioplasty or stenting; n = 213) or carotid endarterectomy (n = 211) in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS), the degree and length of stenosis and plaque surface irregularity were assessed on baseline intraarterial angiography. Outcome measures were stroke or death occurring between randomization and 30 days after treatment, and ipsilateral stroke and restenosis ≥50% during follow-up.ResultsCarotid stenosis longer than 0.65 times the common carotid artery diameter was associated with increased risk of peri-procedural stroke or death after both endovascular treatment [odds ratio 2.79 (1.17–6.65), P = 0.02] and carotid endarterectomy [2.43 (1.03–5.73), P = 0.04], and with increased long-term risk of restenosis in endovascular treatment [hazard ratio 1.68 (1.12–2.53), P = 0.01]. The excess in restenosis after endovascular treatment compared with carotid endarterectomy was significantly greater in patients with long stenosis than with short stenosis at baseline (interaction P = 0.003). Results remained significant after multivariate adjustment. No associations were found for degree of stenosis and plaque surface.ConclusionsIncreasing stenosis length is an independent risk factor for peri-procedural stroke or death in endovascular treatment and carotid endarterectomy, without favoring one treatment over the other. However, the excess restenosis rate after endovascular treatment compared with carotid endarterectomy increases with longer stenosis at baseline. Stenosis length merits further investigation in carotid revascularisation trials.

Long-term risk of carotid restenosis in patients randomly assigned to endovascular treatment or endarterectomy in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): long-term follow-up of a randomised trial

SummaryBackgroundIn the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS), early recurrent carotid stenosis was more common in patients assigned to endovascular treatment than it was in patients assigned to endarterectomy (CEA), raising concerns about the long-term effectiveness of endovascular treatment. We aimed to investigate the long-term risks of restenosis in patients included in CAVATAS.Methods413 patients who were randomly assigned in CAVATAS and completed treatment for carotid stenosis (200 patients had endovascular treatment and 213 patients had endarterectomy) had prospective clinical follow-up at a median of 5 years and carotid duplex ultrasound at a median of 4 years. We investigated the cumulative long-term incidence of carotid restenosis after endovascular treatment and endarterectomy, the effect of the use of stents on restenosis after endovascular treatment, risk factors for the development of restenosis, and the effect of carotid restenosis on the risk of recurrent cerebrovascular events. Analysis was by intention to treat. This study is registered, number ISRCTN01425573.FindingsSevere carotid restenosis (≥70%) or occlusion occurred significantly more often in patients in the endovascular arm than in patients in the endarterectomy arm (adjusted hazard ratio [HR] 3·17, 95% CI 1·89–5·32; p<0·0001). The estimated 5-year incidence of restenosis was 30·7% in the endovascular arm and 10·5% in the endarterectomy arm. Patients in the endovascular arm who were treated with a stent (n=50) had a significantly lower risk of developing restenosis of 70% or greater compared with those treated with balloon angioplasty alone (n=145; HR 0·43, 0·19–0·97; p=0·04). Current smoking or a history of smoking was a predictor of restenosis of 70% or more (2·32, 1·19–4·54; p=0·01) and the early finding of moderate stenosis (50–69%) up to 60 days after treatment was associated with the risk of progression to restenosis of 70% or more (3·76, 1·88–7·52; p=0·0002). The composite endpoint of ipsilateral non-perioperative stroke or transient ischaemic attack occurred more often in patients in whom restenosis of 70% or more was diagnosed in the first year after treatment compared with patients without restenosis of 70% or more (5-year incidence 23% vs 11%; HR 2·18, 1·04–4·54; p=0·04), but the increase in ipsilateral stroke alone was not significant (10% vs 5%; 1·67, 0·54–5·11).InterpretationRestenosis is about three times more common after endovascular treatment than after endarterectomy and is associated with recurrent ipsilateral cerebrovascular symptoms; however, the risk of recurrent ipsilateral stroke is low. Further data are required from on-going trials of stenting versus endarterectomy to ascertain whether long-term ultrasound follow-up is necessary after carotid revascularisation.FundingBritish Heart Foundation; UK National Health Service Management Executive; UK Stroke Association.

Endovascular treatment with angioplasty or stenting versus endarterectomy in patients with carotid artery stenosis in the Carotid And Vertebral Artery Transluminal Angioplasty Study (CAVATAS): long-term follow-up of a randomised trial

SummaryBackgroundEndovascular treatment (angioplasty with or without stenting) is an alternative to carotid endarterectomy for carotid artery stenosis but there are scarce long-term efficacy data showing that it prevents stroke. We therefore report the long-term results of the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS).MethodsBetween March, 1992, and July, 1997, patients who presented at a participating centre with a confirmed stenosis of the internal carotid artery that was deemed equally suitable for either carotid endarterectomy or endovascular treatment were randomly assigned to either treatment in equal proportions by telephone or fax from the randomisation service at the Oxford Clinical Trials Unit, UK. Patients were seen by an independent neurologist at 1 and 6 months after treatment and then every year after randomisation for as long as possible, up to a maximum of 11 years. Major outcome events were transient ischaemic attack, non-disabling, disabling, and fatal stroke, myocardial infarction, and death from any other cause. Outcomes were adjudicated on by investigators who were masked to treatment. Analysis was by intention to treat. This study is registered, number ISRCTN 01425573.Findings504 patients with stenosis of the carotid artery (90% symptomatic) were randomly assigned to endovascular treatment (n=251) or surgery (n=253). Within 30 days of treatment, there were more minor strokes that lasted less than 7 days in the endovascular group (8 vs 1) but the number of other strokes in any territory or death was the same (25 vs 25). There were more cranial nerve palsies (22 vs 0) in the endarterectomy group than in the endovascular group. Median length of follow up in both groups was 5 years (IQR 2–6). By comparing endovascular treatment with endarterectomy after the 30-day post-treatment period, the 8-year incidence and hazard ratio (HR) at the end of follow-up for ipsilateral non-perioperative stroke was 11·3% versus 8·6% (HR 1·22, 95% CI 0·59–2·54); for ipsilateral non-perioperative stroke or TIA was 19·3% versus 17·2% (1·29, 0·78–2·14); and for any non-perioperative stroke was 21·1% versus 15·4% (1·66, 0·99–2·80).InterpretationMore patients had stroke during follow-up in the endovascular group than in the surgical group, but the rate of ipsilateral non-perioperative stroke was low in both groups and none of the differences in the stroke outcome measures was significant. However, the study was underpowered and the confidence intervals were wide. More long-term data are needed from the on going stenting versus endarterectomy trials.FundingBritish Heart Foundation; UK National Health Service Management Executive; UK Stroke Association.

Long-Term Outcome of Endovascular Treatment versus Medical Care for Carotid Artery Stenosis in Patients Not Suitable for Surgery and Randomised in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS)

Background: Optimal treatment of carotid stenosis in patients not suitable for surgery is unclear. The Carotid and Vertebral Artery Transluminal Angioplasty study contained a trial comparing medical and endovascular treatment in patients not suitable for surgery. Methods: Forty patients were randomised to medical or endovascular treatment in equal numbers, and patients were followed up for up to 10 years. The primary outcome measure was defined as stroke or death during follow-up, analysed by intention-to-treat. Secondary analyses included disabling stroke, death, any stroke, any stroke or transient ischemic attack (TIA), all during follow-up. Findings: Baseline characteristics were similar. The risk of stroke, retinal infarction or death within 30 days of endovascular treatment was 5% (95% CI: 0.1–24.9%). By the study end, >50% of patients had suffered a recurrent TIA, stroke or died. One third of events were non-stroke deaths. Overall, there was no significant difference between medical and endovascular treatment in the primary outcome rate of stroke or death after randomisation (hazard ratio: 0.98, 95% CI: 0.39–2.48) or the rate of any stroke or TIA (hazard ratio: 1.43, 95% CI: 0.54–3.75). Interpretation: We failed to show superiority of endovascular treatment above medical care alone for carotid stenosis in a very small group of patients not suitable for surgical treatment. However, the trial randomised only 40 patients, and was therefore severely underpowered to detect clinically relevant treatment differences. Ongoing trials of carotid stenting will need to demonstrate improved safety and efficacy before endovascular treatment should enter routine practice.

Atherosclerotic Peripheral Vascular Disease Symposium II

Carotid artery disease is a major cause of ischemic stroke, the risk of which is directly related to the severity of stenosis and presence of symptoms.1,2 Stroke is the third leading cause of death in the United States, with approximately three quarters of a million strokes per year. Stroke is the leading cause of functional impairment, with more than 20% of survivors requiring institutional care and up to one third having a permanent disability.3 More worrisome, however, is the fact that as the population ages, the number of patients having strokes appears to be increasing.4 The pathophysiology of stroke may be broadly classified as hemorrhagic, embolic, or ischemic. The majority of strokes are caused by embolic events due to atheroemboli from the carotid artery, the ascending aorta, and arch vessels or cardiac thromboembolism from the left atrium or ventricle. It is estimated that carotid artery stenosis is responsible for 15% to 20% of all strokes.5 As percutaneous treatment options expand, there is uncertainty about appropriate therapy for carotid disease. This document will focus on 3 current controversies: (1) carotid artery revascularization in asymptomatic patients, (2) carotid artery stenting (CAS) in patients who are considered to be at increased surgical risk for carotid endarterectomy (CEA), and (3) the current role for CAS in patients at average surgical risk. ### Prevalence and Natural History The prevalence of asymptomatic extracranial carotid stenosis (≥50%) in persons >65 years of age is estimated to be between 5% and 10%, whereas ≤1% of patients are estimated to have a severe narrowing (>80%).6 In asymptomatic patients with ≥50% carotid artery stenoses, the annual risk of stroke is between 1% and 4.3%.2,7 Long-term (10- to 15-year) cohort studies in asymptomatic patients with moderate to severe carotid stenosis demonstrate an ipsilateral stroke rate between 0.9% and 1.1% per …

The Argument to Support Broader Application of Extracranial Carotid Artery Stent Technology

As new technology becomes available, the stent technique for the extracranial carotid artery continues to evolve into a safer, more effective therapy for stroke prevention. With the availability of embolic protection, improved stent designs, and added endovascular physician experience, outcomes for carotid artery stenting (CAS) now consistently parallel those for carotid endarterectomy (CEA). Although carotid endarterectomy was established as the gold standard for carotid revascularization, the available scientific evidence must continue to be interpreted in the context of further advancements in nearly all related areas of medicine. One multicenter randomized trial and several nonrandomized registries have successfully established the CAS indications for patients with high surgical risk and have provided evidence to support the use of CAS techniques in patients with low surgical risk. Clinicians must continue to improve their understanding of patient-specific factors and conduct research that will refine indications while optimizing current medical therapy and that will integrate CAS and carotid endarterectomy as complementary treatments. Response by LoGerfo p 1610 The outcomes for CAS have been improving over the past 10 years and now appear nearly equivalent to those for CEA. In fact, many historical similarities are seen in the development of these 2 techniques. Although CEA was established as the gold standard for extracranial carotid revascularization, the available scientific evidence must continue to be interpreted in the context of further advancements in nearly all related areas of medicine. The current research comparing CAS and CEA has not shown a clinically robust and statistically significant difference between the 2 treatments. When differences do exist, clinicians must continue to refine patient-specific indications and to conduct further research to understand these complex risk-benefit analyses in the context of advanced medical treatments and complementary revascularization techniques. The following review details the argument to support implementation of CAS technology for athero-occlusive carotid …

Major Ongoing Stroke Trials

Major Ongoing Stroke Trials

Major Ongoing Stroke Trials

Major Ongoing Stroke Trials

Invited commentary

This is one of the largest single-center series documenting early and long-term outcomes after carotid angioplasty (CAS) in a selected group of patients deemed “high-risk” for carotid endarterectomy (CEA). In particular, it is one of few published series with 10-year follow-up data. Although it is inevitable that surgeons will disagree with some of the criteria deemed to render patients at higher risk for procedural stroke (asymptomatic atherosclerotic stenosis, asymptomatic post-CEA restenosis, and asymptomatic postradiation stenosis), the title of this paper (conveniently) shifts debate away from patient selection to focus attention on late results. This is a perfectly reasonable aim, bearing in mind the skepticism of many surgeons regarding claims that the late results of CAS are at least equivalent to CEA. In this respect, the data from this paper clearly suggest that the risk of long-term stroke after CAS is remarkably low (10-year freedom from any stroke and ipsilateral stroke was 96% and 98%). These results are much better than most contemporary surgical series and represent an improvement on parallel data from the European Carotid Surgery Trial (ECST), the North American Symptomatic Carotid Endarterectomy Trial (NASCET), the Asymptomatic Carotid Atherosclerosis Study (ACAS) and the Asymptomatic Carotid Surgery Trial (ACST). None of the randomized trials came close to reporting an annual ipsilateral stroke risk of 0.2%, although Bergeron et al do cite other studies with results similar to theirs. Interestingly, the authors have not referenced the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS).1CAVATAS InvestigatorsEndovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVITAS) A randomised trial.Lancet. 2001; 357: 1729-1737Abstract Full Text Full Text PDF PubMed Scopus (1363) Google Scholar Although criticized for its high procedural risk, the “much maligned” CAVATAS trial is one of the few randomized studies to have shown that following successful CAS, there is no significant difference in the risk of late stroke when compared with CEA. Notwithstanding the low risk of late stroke, which is actually the most important end-point to consider, surgeons have also been critical of apparently higher rates of restenosis after CAS compared with CEA, citing this as a major limitation for the future. Once again, the data from Bergeron would seem to suggest that this concern is unfounded. In their study, cumulative freedom from restenosis >50% was 1.8%, 3.2%, and 6.8% at 1, 2 and 10 years, respectively—again, much lower than most contemporary surgical series. In CAVATAS, CAS patients incurred a 14% risk of restenosis >70% at 1 year compared with 6.7% in CEA patients. Quite why this difference should be so marked is unknown, but merits further study. This paper has not settled issues regarding patient selection and generalizability (key unresolved issues), but it does contribute towards an increasing body of evidence that long-term outcomes are probably no different to CEA. Long-term results of carotid stenting are competitive with surgeryJournal of Vascular SurgeryVol. 41Issue 2PreviewThe feasibility of carotid stenting (CS) is no longer questionable, although its indications remain debatable. Until the results of randomized trials are available, personal series and registries should help in the comparison of long-term results of CS with those of endarterectomy. We report here the long-term results of a large series of CS in our department with a long follow-up. This retrospective study reviews a single surgeon’s 11-year experience with CS. Our results are compared with those of conventional surgery emanating from our own series and the North American Symptomatic Carotid Endarterectomy Trial (NASCET), European Carotid Surgery Trial (ECST), and Asymptomatic Carotid Atherosclerosis Study (ACAS). Full-Text PDF Open Archive

Major Ongoing Stroke Trials

Major Ongoing Stroke Trials

Restenosis After Carotid Angioplasty, Stenting, or Endarterectomy in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS)

Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS) patients with carotid stenosis were randomized between endovascular treatment and endarterectomy. The rates of residual severe stenosis and restenosis and their contribution to recurrent symptoms was unclear. Endovascular patients were treated by balloon angioplasty alone (88%) or stenting (22%). Patches were used in 63% of endarterectomy patients. Carotid stenosis was categorized as mild (0% to 49%), moderate (50% to 69%), severe (70% to 99%), or occluded, using standardized Doppler ultrasound criteria at the examination closest to 1 month (n=283) and 1 year (n=347) after treatment. Recurrent cerebrovascular symptoms during follow-up were analyzed. More patients had > or =70% stenosis of the ipsilateral carotid artery 1 year after endovascular treatment than after endarterectomy (18.5% versus 5.2%, P=0.0001). Residual severe stenosis was present in 6.5% of patients at 1 month after endovascular treatment. Between 1 month and 1 year, restenosis to > or =70% stenosis occurred in 10.5% of the endovascular group. After endarterectomy, 1.7% had residual severe stenosis at 1 month, and 2.5% developed severe restenosis. The results were significantly better after stenting compared with angioplasty alone at 1 month (P<0.001) but not at 1 year. Recurrent ipsilateral symptoms were more common in endovascular patients with severe stenosis (5/32 [15.6%]) compared with lesser degrees of stenosis at 1 year (11/141 [7.8%], P=0.02), but most were transient ischemic attacks and none were disabling or fatal strokes. There were no recurrent symptoms in the 9 endarterectomy patients with > or =70% stenosis at 1 year. Carotid stenosis 1 year after endovascular treatment is partly explained by poor initial anatomical results and partly by restenosis. The majority of patients were treated by angioplasty without stenting. Further randomized studies are required to determine whether newer carotid stenting techniques are associated with a lower risk of restenosis. The low rate of recurrent stroke in both endovascular and endarterectomy patients suggests that treatment of restenosis should be limited to patients with recurrent symptoms, but long term follow up data are required.

Carotid Stent Placement, Stroke Prevention, and Training

Carotid Stent Placement, Stroke Prevention, and Training

Carotid Artery Stenting:The Need for Randomised Trials

Endovascular treatment for carotid artery stenosis avoids some of the complications of carotid endarterectomy, but has not been widely accepted. Concerns about the risks and benefits of endovascular treatment led to the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS). There was no difference in major outcome events between endovascular treatment and carotid endarterectomy, but the rate of procedural stroke or death was higher than desirable. There was no difference either in the rate of stroke during follow-up, but the confidence intervals were very wide and severe ipsilateral carotid stenosis was more frequent 1 year after endovascular treatment than after carotid surgery. Two other randomised trials of carotid stenting were stopped early after poor outcomes in stented patients. These early trials used techniques which have now been superseded, but the results emphasise the need to improve the safety of endovascular treatment. Recent advances designed to improve safety include new designs of stents and delivery systems, and devices designed to protect the brain from embolisation during stenting. However, there is little convincing evidence that these new devices reduce the rate of stroke. Moreover, a systematic review of the existing randomised trial data concluded that there the current evidence does not support a shift away from recommending carotid endarterectomy as the standard treatment for carotid stenosis. There is therefore a clear need for further randomised trials of carotid stenting. Three of the ongoing trials, EVA-3S, SPACE and ICSS (CAVATAS-2), have prospectively agreed to combine individual patient data after completion of follow-up. This meta-analysis will provide results similar to a mega-trial and should also allow informative subgroup analyses. The co-operation between the trials in agreeing to perform this meta-analysis is a major advance in trial design. The result should determine whether carotid stenting truly rivals carotid endarterectomy as the treatment of choice for carotid stenosis.

Major Ongoing Stroke Trials

Major Ongoing Stroke Trials

Effective treatment of carotid artery stenosis on blood pressure: a comparison of hemodynamic disturbances after carotid endarterectomy in endovascular treatment

Conclusion: Carotid endarterectomy and endovascular treatment of carotid artery stenosis both affect blood pressure stability during the first 24 hours after the procedure. Compared with preoperative baseline levels, systolic blood pressure at 6 months is lower in patients who undergo surgery, and is unchanged in patients who undergo endovascular treatment. Summary: Periprocedure and long-term blood pressure effects of carotid endarterectomy and endovascular treatment of carotid artery stenosis were studied in patients randomized at a single center in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS). Patients were randomized to endovascular treatment of carotid stenosis (n = 55) or carotid endarterectomy (n = 49). Ambulatory 24-hour blood pressure monitoring was recorded before carotid intervention and at 24 hours, 1 month and 6 months after intervention. Hypotension and hypertension were defined as a decrease or increase, respectively, in systolic blood pressure of 30 mm Hg or greater from baseline blood pressure recordings. After the procedure, in the first 24 hours hypotension occurred in 76% of the endovascular group and 75% of the carotid endarterectomy group, and hypertension occurred in 13% and 11%, respectively. At 1 hour systolic blood pressure decreased by a mean of 24 mm Hg in the surgical group and 16 mm Hg in the endovascular group; however, the decrease was sustained only in the endovascular group (P < .0001). At 6 months systolic pressure was at baseline in the endovascular group, and was 5 mm Hg lower in the surgical group. Thirty-day stroke and mortality rate was 10.2% in the surgical group, and 5.5% in the endovascular group. Perioperative neurologic complication was not related to perioperative hemodynamic disturbance. Comment: The study suggests a difference in blood pressure response after surgical versus endovascular therapy for carotid artery stenosis. In surgical patients, however, a specific protocol was used to reverse hypotension, whereas no specific protocol was used in the stent group. The 6-month data are difficult to interpret, because there is no follow-up information on number and dosage of antihypertensive medications in either group. This study should be regarded as hypothesis-seeking, and does not definitively establish a difference in blood pressure response after carotid endarterectomy versus carotid stenting.

Major Ongoing Stroke Trials

Major Ongoing Stroke Trials

Rationale and status of randomized controlled clinical trials in carotid artery stenting

Efficacy for carotid artery stenting (CAS) has not been confirmed by randomized clinical trial methodology. Although carotid endarterectomy (CEA) is considered the preferred method for carotid revascularization in the management of patients with asymptomatic and symptomatic extracranial carotid occlusive disease, comparisons between CAS and CEA are now underway. In North America, the CREST (Carotid Revascularization Endarterectomy versus Stent Trial) protocol is now completing credentialing cases as randomization of cases is initiated. In Europe, the CAVATAS (Carotid and Vertebral Artery Transluminal Angioplasty Study) and SPACE (Stent Protected Angioplasty versus Carotid Endarterectomy) trials are recruiting symptomatic patients for randomization between CEA and CAS. It is anticipated that these trials will publish definitive results within the next 1-3 years and help guide the referral of patients for CAS and CEA in the future.

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Major Ongoing Stroke Trials

Major Ongoing Stroke Trials