Lessons from carotid endarterectomy and stenting trials.

摘要

In trial after trial, carotid stenting (CAS) does not replace carotid endarterectomy (CEA) for symptomatic carotid stenosis revascularisation. In The Lancet today, a meta-analysis of pooled individual patient data from the Endarterectomy versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S) trial, the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) trial, and the Internationa! Carotid Stenting Study (ICSS) confirms the higher periprocedural risk of stroke or death rate with CAS than with CEA (8.9% vs 5.8%). However, the investigators found heterogeneity between different age-groups, with a significant difference recorded only between CAS and CEA in patients older than 70 years (12.0% vs 5.9%, risk ratio 204,95% Cl 1.48-2.82, interaction p=0.0053). In patients younger than 70 years, no difference was noted between CAS and CEA, but the 95% confidence interval (0.68-1.47) does not exclude a difference in either direction.