Symptomatic Carotid Stenosis — Long-Term Data Favor CEA Over CAS

Classic Article Review  – Background: Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are established revascularization strategies for recently symptomatic carotid stenosis. Prior randomized trials demonstrated higher periprocedural stroke risk with CAS, but limited follow-up in individual studies left uncertainty regarding long-term durability and whether early differences persisted over time. Objective: To determine long-term comparative outcomes of CAS versus CEA in symptomatic carotid stenosis using pooled individual patient-level data from 4 major randomized controlled trials. Design: Preplanned pooled analysis. Methods: The authors obtained individual patient data from EVA-3S (Endarterectomy versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis), SPACE (Stent-Protected Percutaneous Angioplasty of the Carotid Artery versus Endarterectomy), ICSS (International Carotid Stenting Study), and the symptomatic cohort of CREST (Carotid Revasculariza more...