title: Stenting versus endarterectomy for treatment of carotid-artery stenosis.
abstract: BACKGROUND
  Carotid-artery stenting and carotid endarterectomy are both options for treating carotid-artery stenosis, an important cause of stroke.
  
  
  METHODS
  We randomly assigned patients with symptomatic or asymptomatic carotid stenosis to undergo carotid-artery stenting or carotid endarterectomy. The primary composite end point was stroke, myocardial infarction, or death from any cause during the periprocedural period or any ipsilateral stroke within 4 years after randomization.
  
  
  RESULTS
  For 2502 patients over a median follow-up period of 2.5 years, there was no significant difference in the estimated 4-year rates of the primary end point between the stenting group and the endarterectomy group (7.2% and 6.8%, respectively; hazard ratio with stenting, 1.11; 95% confidence interval, 0.81 to 1.51; P=0.51). There was no differential treatment effect with regard to the primary end point according to symptomatic status (P=0.84) or sex (P=0.34). The 4-year rate of stroke or death was 6.4% with stenting and 4.7% with endarterectomy (hazard ratio, 1.50; P=0.03); the rates among symptomatic patients were 8.0% and 6.4% (hazard ratio, 1.37; P=0.14), and the rates among asymptomatic patients were 4.5% and 2.7% (hazard ratio, 1.86; P=0.07), respectively. Periprocedural rates of individual components of the end points differed between the stenting group and the endarterectomy group: for death (0.7% vs. 0.3%, P=0.18), for stroke (4.1% vs. 2.3%, P=0.01), and for myocardial infarction (1.1% vs. 2.3%, P=0.03). After this period, the incidences of ipsilateral stroke with stenting and with endarterectomy were similarly low (2.0% and 2.4%, respectively; P=0.85).
  
  
  CONCLUSIONS
  Among patients with symptomatic or asymptomatic carotid stenosis, the risk of the composite primary outcome of stroke, myocardial infarction, or death did not differ significantly in the group undergoing carotid-artery stenting and the group undergoing carotid endarterectomy. During the periprocedural period, there was a higher risk of stroke with stenting and a higher risk of myocardial infarction with endarterectomy. (ClinicalTrials.gov number, NCT00004732.)
authors.affiliation: Mayo Clinic, Griffin 304, 4500 San Pablo Rd., Jacksonville, FL 32224, USA. brott.thomas@mayo.edu
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Brott
authors.forename: Robert W
authors.initials: RW
authors.lastname: Hobson
authors.forename: George
authors.initials: G
authors.lastname: Howard
authors.forename: Gary S
authors.initials: GS
authors.lastname: Roubin
authors.forename: Wayne M
authors.initials: WM
authors.lastname: Clark
authors.forename: William
authors.initials: W
authors.lastname: Brooks
authors.forename: Ariane
authors.initials: A
authors.lastname: Mackey
authors.forename: Michael D
authors.initials: MD
authors.lastname: Hill
authors.forename: Pierre P
authors.initials: PP
authors.lastname: Leimgruber
authors.forename: Alice J
authors.initials: AJ
authors.lastname: Sheffet
authors.forename: Virginia J
authors.initials: VJ
authors.lastname: Howard
authors.forename: Wesley S
authors.initials: WS
authors.lastname: Moore
authors.forename: Jenifer H
authors.initials: JH
authors.lastname: Voeks
authors.forename: L Nelson
authors.initials: LN
authors.lastname: Hopkins
authors.forename: Donald E
authors.initials: DE
authors.lastname: Cutlip
authors.forename: David J
authors.initials: DJ
authors.lastname: Cohen
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Popma
authors.forename: Robert D
authors.initials: RD
authors.lastname: Ferguson
authors.forename: Stanley N
authors.initials: SN
authors.lastname: Cohen
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Blackshear
authors.forename: Frank L
authors.initials: FL
authors.lastname: Silver
authors.forename: J P
authors.initials: JP
authors.lastname: Mohr
authors.forename: Brajesh K
authors.initials: BK
authors.lastname: Lal
authors.forename: James F
authors.initials: JF
authors.lastname: Meschia
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D011788:Quality of Life; D015607:Stents / Q000009:adverse effects; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control