Do we need a new carotid artery stenting trial ?

Abstract

Four well-conducted carotid artery trials comparing carotid artery stenting with carotid artery endarterectomy (EVA-3S, SPACE, ICSS and CREST) could not demonstrate the superiority of carotid artery stenting (CAS) over carotid artery endarterectomy (CEA). There is at the moment no level-I evidence to support widespread use of endovascular management of carotid artery disease in routine practice.

In order to shead some light on the continuing debate on the role of carotid artery stenting, the authors conducted a search in contemporary published literature concerning carotid artery stenting.

This extensive literature review reveals a higher peri-procedural stroke-death rate after CAS and a higher cost. Two other events hamper the value of CAS: a higher late restenosis rate and a higher risk of micro-embolisation during the procedure, compared with CEA.

The authors conclude that the prevailing overenthousiasm of interventionalists (vascular surgeons, radiologists, cardiologists) for carotid artery stenting is not justified.

Key Words:

• Carotid artery stenting
• randomised controlled trial
• carotid artery disease.

Additional information

Notes on contributors

H. Van Damme

H. Van Damme, M.D., Ph.D. C.H.U. Liège, B 35 Domaine Universitaire du Sart-Tilman 4000 Liège, Belgium Tel.: [phone] Fax: [phone] E-mail: [email protected]