Carotid angioplasty and stenting versus carotid endarterectomy: randomized trial in a community hospital

J Am Coll Cardiol. 2001 Nov 15;38(6):1589-95. doi: 10.1016/s0735-1097(01)01595-9.


Objectives: The goal of this study was to determine whether carotid angioplasty and stenting (CAS) is equivalent to carotid endarterectomy (CEA) in patients with symptomatic carotid stenosis >70% by a randomized, controlled trial in a community hospital.

Background: Carotid angioplasty and stenting has been suggested to be as effective as CEA for treatment of symptomatic carotid artery stenosis.

Methods: A total of 104 patients presenting with cerebrovascular ischemia ipsilateral to carotid stenosis were selected randomly for CEA or carotid stenting and followed for two years.

Results: Stenosis decreased to an average of 5% after CAS. The patency of the reconstructed artery remained satisfactory regardless of the technique as determined by sequential ultrasound. One death occurred in the CEA group (1/51); one transient ischemic attack occurred in the CAS group (1/53); no individual sustained a stroke. The perception of procedurally related pain/discomfort was similar. Hospital stay was similar, although the CAS group tended to be discharged earlier (mean = 1.8 days vs. 2.7 days). Complications associated with CAS prolonged hospitalization when compared with those sustaining a CEA-related complication (mean = 5.6 days vs. 3.8 days). Return to full activity was achieved within one week by 80% of the CAS group and 67% of the patients receiving CEA. Hospital charges were slightly higher for CAS.

Conclusions: Carotid stenting is equivalent to CEA in reducing carotid stenosis without increased risk for major complications of death/stroke. Because of shortened hospitalization and convalescence, CAS challenges CEA as the preferred treatment of symptomatic carotid stenosis if a reduction in costs can be achieved.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Analysis of Variance
  • Angioplasty, Balloon*
  • Brain Ischemia / etiology
  • Carotid Stenosis / complications
  • Carotid Stenosis / therapy*
  • Endarterectomy, Carotid*
  • Female
  • Hospital Charges
  • Hospital Costs
  • Hospitals, Community
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Pain Measurement
  • Postoperative Complications
  • Risk Factors
  • Stents*
  • Treatment Outcome
  • Vascular Patency