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Is carotid artery stenting equivalent or superior to carotid endarterectomy for treatment of carotid artery stenosis?

^a Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
^b Department of Interventional Radiology, Freeman Hospital, Newcastle, UK

*Corresponding author. Tel./Fax: +44-780-1548122.

E-mail address: joeldunning{at}doctors.org.uk (J. Dunning).

A best evidence topic in vascular surgery was written according to a structured protocol. The question addressed was whether carotid artery stenting (CAS) is equivalent or even superior to carotid endarterectomy (CEA) for the treatment of significant carotid artery stenosis. Four hundred and ninety-four papers were identified, of which 14 papers including five randomised controlled trials (RCTs) presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. We conclude that the risk of peri-procedure stroke or death was similar for patients treated with carotid artery angioplasty±stenting and those treated with surgery. However, CAS did reduce the risk of minor complications at the site of vascular access, the incidence of cranial nerve injury, and may reduce economic costs due to shorter hospital stays and earlier return to work. Long term follow-up of these patients is, however, lacking. There are currently four large multi-centre RCTs in progress and their results will determine whether CAS will surpass CEA as the gold standard in the future.

Key Words: Evidence-based medicine; Carotid-artery stenting; Carotid endarterectomy; Carotid stenosis

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