Endarterectomy versus Stenting for Carotid Stenosis

Publisher Website
Google Scholar
Abstract
Mas et al. (Oct. 19 issue)1 report the results of the randomized Endarterectomy versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S) trial, which suggest the superiority of carotid endarterectomy over carotid-artery stenting in patients with symptomatic stenosis of at least 60%. The results are similar to the recently reported findings in the Stent-Protected Angioplasty versus Carotid Endarterectomy in Symptomatic Patients (SPACE) study.2 However, some points deserve comment. First, the most active center in the trial included few patients (approximately 10 per year). Second, in an important proportion of cases (5%), carotid-artery stenting failed and endarterctomy had to be performed. Third, only distal filters were used as embolic protection devices; no proximal-flow blockage systems were used.3,4 Fourth, the median carotid-artery stenting time was quite long (70 minutes), suggesting that the patients' anatomy was complex or that the technical skills of the operators were still in the learning curve.5 Thus, the main message of the EVA-3S trial might be that carotid-artery stenting remains a complex procedure that should be performed in high-volume, specialized centers, where tailored carotid-artery stenting procedures are performed according to the specific characteristics of the patient and lesion.