The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)


Current controversies in carotid artery stenting


1. Department of Surgery, Northwestern University, Chicago, Illinois, USA; 2. Department of Surgery, Erasmus University, Rotterdam, The Netherlands
Large landmark trials (NASCET, ECST, ACAS and ACST)1-4 firmly established the indications for carotid endarterectomy (CEA) in patients with symptomatic stenosis of > 50%, and asymptomatic stenosis of > 60%. Single- and multicentre randomised trials (CAVATAS, Kentucky study, Leicester study, Wallstent study, SAPPHIRE), and two recently published multicentre trials (SPACE and EVA-3S), have directly compared CEA to carotid artery stenting (CAS), and have generated widespread debate with conflicting results. At this juncture, acknowledgement of the hard work performed by these investigators, critical analysis of trial methodology, and reassessment of the utility of CAS is appropriate.

CAVATAS randomised 504 patients, 88% of ...

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