Carotid Artery Stenting (CAS) Outcomes May Vary Between Operators/Institutions. The Results from Centers of CAS Excellence May Not Be Generalizeable

The debate between carotid artery stenting (CAS) and carotid endarterectomy (CEA) for the management of carotid stenosis continues. Supporters of CAS claim that CAS has achieved clinical equipoise with CEA.1,2 In contrast, based on the results of multicenter RCTs,3-5 others argue that it is currently premature to conclude that CAS is as effective as CEA.6 Even in the best academic centers, CAS is consistently associated with significantly higher rates of stroke or death compared with CEA.6 The CAS supporters counterattack by saying that the RCTs3-5 demonstrating that CEA is superior to CAS had seriously flawed designs, namely: 1) no quality control for CAS operators, 2) no use of emboli-protecting devices, and, 3) unequally experienced CEA and CAS operators.
Source: Annals of Vascular Surgery - Category: Surgery Authors: Source Type: research