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Prospective Randomized Trials of Carotid Artery Stenting Versus Carotid Endarterectomy: An Appraisal of the Current Literature

Michael E. DeBakey Department of Surgery, Division of Vascular Surgery & Endovascular Therapy, Baylor College of Medicine, and Michael E. DeBakey VA Medical Center, Houston, Texas, plin{at}bcm.edu

Neal R. Barshes, MD

Michael E. DeBakey Department of Surgery, Division of Vascular Surgery & Endovascular Therapy, Baylor College of Medicine, and Michael E. DeBakey VA Medical Center, Houston, Texas

Suman Annambhotla, MD

Michael E. DeBakey Department of Surgery, Division of Vascular Surgery & Endovascular Therapy, Baylor College of Medicine, and Michael E. DeBakey VA Medical Center, Houston, Texas

Tam T. Huynh, MD

Michael E. DeBakey Department of Surgery, Division of Vascular Surgery & Endovascular Therapy, Baylor College of Medicine, and Michael E. DeBakey VA Medical Center, Houston, Texas

Carotid artery stenting has emerged as a treatment alternative in patients at high risk for carotid endarterectomy. Recent technological advances in catheter-based intervention have both facilitated the procedure and possibly improved the clinical outcome of this percutaneous intervention. The reduction in device profile of introducer sheaths and stents, as well as the ubiquitous use of neuroprotection devices, has resulted in a greater application of this treatment modality in patients with carotid bifurcation disease. The efficacy of carotid artery stenting must be carefully evaluated against carotid endarterectomy in a prospective randomized manner, as the latter treatment has long been considered the standard treatment of carotid occlusive disease. Several recent clinical trials comparing carotid artery stenting versus carotid endarterectomy have yielded mixed results with regard to the efficacy of this percutaneous intervention. This article analyzed the results of these prospective randomized trials comparing carotid artery stenting and carotid endarterectomy. Critical appraisal of these trials, as well as relevant methodological issues of these investigations, is discussed in this article.

Key Words: carotid artery stenting • carotid endarterectomy • clinical trials

Vascular and Endovascular Surgery, Vol. 42, No. 1, 5-11 (2008)
DOI: 10.1177/1538574407312654


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