Stenting led to more stroke or death than did endarterectomy in symptomatic carotid stenosis 60%

摘要

First the good news: Noninferiority trials can (although sometimesndon’t) ask clinically sensible questions. Once we are convinced that antreatment does more good than harm, if somebody comes up with annew, alternative treatment, there are 2 clinically sensible questions to benasked. First, is the new treatment better than (“superior to”) the establishedntreatment? Second, if the new treatment is not better, is it “asngood as” the established treatment but preferable in some other wayn(e.g., safety, comfort, or cost)? To answer these 2 questions, we wouldncarry out a “head-to-head” trial comparing the old and new treatments.nAt the trial’s conclusion, we would want to know how confident wencould be in our answers to these 2 questions; we would want anynobserved differences (“better than”) or similarities (“as good as”) to benvery unlikely to be due to chance.