- Question
- Does adding carotid revascularization (stenting or endarterectomy) to intensive medical management provide greater benefit than intensive medical management alone in patients with high-grade asymptomatic carotid stenosis?
- Design
- Two parallel, randomized, observer-blinded trials conducted at 155 centers in five countries. The stenting trial randomized 1245 patients and the endarterectomy trial 1240, with follow-up of up to 4 years.
- Population
- Patients with high-grade (≥70%) carotid stenosis without recent symptoms.
- Intervention
- Carotid stenting plus intensive medical management (stenting trial) or carotid endarterectomy plus intensive medical management (endarterectomy trial).
- Control
- Intensive medical management alone.
- Primary outcome
- Composite of any stroke or death from randomization to day 44, or ipsilateral ischemic stroke during the remaining follow-up, up to 4 years.
- Results
- In the stenting trial, the 4-year incidence of the primary outcome was 6.0% (95% CI, 3.8 to 8.3) with medical therapy and 2.8% (95% CI, 1.5 to 4.3) with stenting (P = 0.02 for the absolute difference). In the endarterectomy trial it was 5.3% (95% CI, 3.3 to 7.4) with medical therapy and 3.7% (95% CI, 2.1 to 5.5) with endarterectomy (P = 0.24).
- Safety
- From day 0 to 44, the stenting trial had no strokes or deaths in the medical-therapy group and seven strokes and one death in the stenting group; the endarterectomy trial had three strokes in the medical-therapy group and nine strokes in the endarterectomy group.
- Conclusion
- In high-grade stenosis without recent symptoms, adding stenting lowered the risk of perioperative stroke or death or ipsilateral stroke within 4 years compared with intensive medical management alone, whereas endarterectomy did not show a significant benefit.
- Why it matters
- It provides contemporary randomized evidence for choosing between revascularization and intensive medical therapy in asymptomatic carotid stenosis, a question reopened by advances in medical treatment.
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