Elsevier

The Lancet

Volume 376, Issue 9746, 25 September–1 October 2010, Pages 1028-1031
The Lancet

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Lessons from carotid endarterectomy and stenting trials

https://doi.org/10.1016/S0140-6736(10)61415-8Get rights and content

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    Although there is significant progress in endovascular technology, multiple trials have failed to show equivalency in outcomes between carotid artery stenting (CAS) and carotid endarterectomy (CEA).1–3

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    An analysis of pooled data from the EVA-3S, SPACE, and ICSS clearly demonstrated an overall higher periprocedural risk of stroke and death with CAS compared to endarterectomy.8 Further stratification localized the higher periprocedural stroke and death rates to patients over 70 years of age (12.0% vs 5.9%; P = .0053).8 A similar increased stroke risk in patients >70 years of age was found in the CREST.6

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    However, addressing the primary end point of any stroke, MI, or death up to 4 years after intervention, the null hypothesis was to be accepted (8, 21). The inclusion of asymptomatic cardiac ischemia as a primary end point in CREST has been criticized by a number of commentators (3). Silent cardiac events are not generally used as an end point in comparable contemporary European trials (3).

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