- Question
- In asymptomatic patients with severe carotid stenosis, does carotid artery stenting (CAS) provide long-term stroke protection comparable to carotid endarterectomy (CEA)?
- Design
- International, multicentre, randomised trial of CAS versus CEA enrolling 3625 patients in 130 centres between 2008 and 2020, with a mean follow-up of 5 years. Intention-to-treat analysis.
- Population
- Patients with no recent stroke or transient cerebral ischaemia and severe unilateral or bilateral carotid stenosis, for whom doctor and patient agreed a carotid procedure was needed but were substantially uncertain which one to choose.
- Intervention
- Carotid artery stenting (CAS), with 1811 patients allocated.
- Control
- Carotid endarterectomy (CEA), with 1814 patients allocated.
- Primary outcome
- Procedural events (within 30 days of the intervention) and non-procedural stroke during follow-up, including fatal or disabling stroke and any stroke.
- Results
- Overall, 1% had procedural disabling stroke or death (15 with CAS and 18 with CEA) and 2% had non-disabling procedural stroke (48 with CAS and 29 with CEA). At 5 years, non-procedural fatal or disabling stroke was 2.5% in each group, and any stroke was 5.3% with CAS versus 4.5% with CEA (rate ratio 1.16, 95% CI 0.86-1.57; p=0.33).
- Conclusion
- Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of the two procedures on fatal or disabling stroke are comparable.
- Why it matters
- It provided large-scale randomised evidence supporting either stenting or surgery for asymptomatic carotid stenosis, allowing the choice to be individualised to the patient and the centre's expertise.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 14, 2026