Non-inferiority of stenting vs endarterectomy for asymptomatic carotid stenosis in non-high-risk patients

CV
Source: 
New England Journal of Medicine

Previous clinical trials suggest that carotid artery stenting is an effective alternative to endarterectomy in patients who are at average or high risk for surgical complications. The Carotid Angioplasty and Stenting Versus Endarterectomy in Asymptomatic Patients Trial was carried out in 1,453 patients with severe carotid stenosis who were asymptomatic and not considered to be at high risk for surgery. Stenting was non-inferior to endarterectomy with respect to the primary end points of death, stroke, and myocardial infarction within 30 days of the procedure or ipsilateral stroke within 1 year (3.8% and 3.4%, respectively).  The cumulative 5-year rate of stroke-free survival was 93.1% in the stenting group and 94.7% in the endarterectomy group and overall survival rates were also not significantly different between cohorts (87.1% and 89.4%, respectively).  This study adds evidence that carotid artery stenting is an effective alternative to endarterectomy in asymptomatic patients with severe stenosis even in patients who are not considered to be at high risk for surgery.

Robert M. Starke, MD MSC
Charlottesville, VA