An evolution in thinking from modern carotid registries: CAS and CEA will be complimentary and not competitive techniques.

摘要

Stroke is the third leading cause of death in the United States, with an estimated societal cost of at least Dollars 55 billion. Carotid atherosclerotic plaque instability and rupture accounts for about a third of all ischemic strokes. The ideal mode for treating the vulnerable plaque has been rigorously debated; in the past decade, carotid endarterectomy (CEA) and carotid angioplasty stenting (CAS) have usually been compared head-to-head. In 2006, two international randomized controlled trials (RCTs) [1,2] sought out to compare the two techniques, but both had significant shortcomings, including inadequate training of the CAS interventionalists (EVA-3S) and an unusually high CEA-stroke rate (SPACE).