[Stenting of symptomatic stenosis of the internal carotid artery is not preferred over endarterectomy at this time]

Abstract

Carotid endarterectomy reduces the risk of stroke in patients with symptomatic internal carotid-artery stenosis of 50% or greater. Carotid-artery stenting may be an attractive alternative. Two randomised trials comparing carotid endarterectomy with stenting have recently been terminated prematurely. Reasons for termination included an excess in stroke and death after stenting, compared with carotid endarterectomy (the EVA-3S trial) and futility reasons and the absence of funding (the SPACE trial). Given that both trials failed to prove the non-inferiority of stenting compared with carotid endarterectomy in the first 30 days, the use of stenting should be restricted to patients with contraindications to surgery and those participating in randomised clinical trials.