Surgery does it better

Implications: This study investigated carotid endarterectomy versus carotid stenting in patients with severe carotid stenosis. The study was stopped prematurely due to safety and futility. The 30-day incidence of stroke or death was 3.9% versus 9.6% for endarterectomy versus carotid stenting. This data implies that carotid stenting with cerebral protection is inferior to surgical endarterectomy, and therefore will not be as widely adopted as previous thought.

Analysis: The data provided indicate that patients with symptomatic carotid stenosis of 60% or more should be treated with endarterectomy and stent use should be reserved for the high risk or recurrent stenotic carotid arteries. This would decrease or certainly curtail the current use of carotid stenting and associated cerebral protection devices.