CAS, carotid endarterectomy similarly protective against str
In patients with asymptomatic severe carotid stenosis requiring intervention, there was no difference in 5-year stroke risk between those assigned carotid artery stenting and those assigned carotid endarterectomy.

Results were presented at the European Society of Cardiology Congress and simultaneously published in The Lancet.

“Trials have shown that adding CEA approximately halves stroke rates over the next 5 years, and the question in this trial is, is CAS equally effective?” researcher said during a press conference.

All patients had carotid artery stenosis of at least 60% on ultrasound but “do not have a recent stroke or other neurological symptoms,” researchers said. “They are thought to need some carotid procedure, either CEA or CAS, but the doctor and the patient must be both substantially uncertain which of these to prefer in order to enter the trial.”

Thirty percent were women and approximately half were aged 70 years or older.

Procedural death or disabling stroke occurred in 1% of both groups and procedural nondisabling stroke occurred in 2% of both groups.

At 5 years, the Kaplan-Meier estimate of rates of fatal or disabling stroke was 2.5% in both groups, while the Kaplan-Meier estimate of rates of any stroke were 5.3% in the CAS group and 4.5% in the surgery group, according to the results.

“Both procedures approximately halved long-term risk from about 1% to about 0.5% per year,” Halliday said. “However, with stenting, there is a 1% to 2% excess risk of nondisabling stroke that left patients still able to carry out all of their previously usual activities.”

When the researchers performed a meta-analysis of all CAS vs. carotid endarterectomy trials, there was no difference between the procedures in risk for any nonprocedural stroke, with the results consistent in symptomatic and asymptomatic patients.

“For disabling and fatal stroke, CAS and CEA involve similar risks and similar benefits,” researchers said, noting the researchers plan to follow the patients for 10 years.

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01910-3/fulltext
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