Trials in progress.
Nine completed randomized clinical trials (RCTs) failed to show any advantage of carotid angioplasty and stenting (CAS) over carotid surgery, whereas a number of larger trials were recently developed and are still ongoing or have just released interim data analysis. These new RCTs, giving emphasis to CAS carried out with appropriate credentialing and updated technology should be appropriately powered. According to last published data, carotid revascularization performed by highly qualified surgeons and interventionalists might be safe and effective; nevertheless, stroke is more likely after carotid stenting, whereas myocardial infarction is more likely after surgery, and the 2 risks need to be balanced in selecting the indication for treatment in specific patients. It is hoped that ongoing RCTs will clarify a couple of other issues: (1) the benefit of CAS in "asymptomatic" patients with respect not only to surgery but also to medical therapy alone and (2) which subgroups of patients at "average risk" would benefit more from CAS. Final results from pending RCTs are eagerly awaited to manage the common practice with CAS.
Cao
Piergiorgio
P
U. O. C. Chirurgia Vascolare, Dipartimento di Cardioscienze, Azienda Ospedaliera S. Camillo-Forlanini, Roma, Italy. pcao@unipg.it
De Rango
Paola
P
Cieri
Enrico
E
Verzini
Fabio
F
Parlani
Gianbattista
G
D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation*; D016893:Carotid Stenosis / Q000150:complications / Q000601:surgery / Q000628:therapy*; D002983:Clinical Competence; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D019317:Evidence-Based Medicine; D006801:Humans; D009203:Myocardial Infarction / Q000209:etiology / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome