Endarterectomy associated with less peri-procedural strokes than stenting for symptomatic carotid stenosis


Long-term follow-up results of the randomized controlled trial “Endarterectomy Versus Angioplasty in Patients With Symptomatic Severe Carotid Stenosis” (EVA-3S) of 527 patients randomized to carotid stenting or endarterectomy at 30 French centers reported primary endpoints of ipsilateral stroke or procedural stroke or death for 30 patients in the stenting group compared to 18 patients after endarterectomy, at a median follow-up of 7.1 years (range 5.1–8.8 years; max 12.4 years). Cumulative probabilities were significantly higher after stenting (11.0%) versus endarterectomy (6.3%) at 5 years, but not significantly different at 10 years (11.5% versus 7.6%, p=0.07).  No difference was observed between treatments for long term rates of ipsilateral strokes, severe carotid restenosis (≥70%) or occlusion, death, myocardial infarction, or more revascularization procedures. This data favors endarterectomy over carotid stenting for symptomatic carotid stenosis, driven by a lower risk of procedural stroke after endarterectomy.

Robert M. Starke, MD MSc
Miami, FL