Heart 2009;95:1708-1710
Technology and guidelines
Carotid disease: stenting versus endarterectomy
Correspondence to Professor A R Naylor, Department of Vascular Surgery, Clinical Sciences Building, Leicester Royal Infirmary, Leicester LE2 7LX, UK; ross.naylor@uhl-tr.nhs.uk
Accepted 3 February 2009
| The first 150 words of the full text of this article appear below. |
Introduced in the 1950s, carotid endarterectomy (CEA) proliferated in the 1970s, only to become the subject of criticism in the 1980s when its appropriateness was questioned.1 Primacy was restored with the European Carotid Surgery Trial (ECST) and the North American Symptomatic Carotid Endarterectomy Trial (NASCET) in symptomatic patients followed by the Asymptomatic Carotid Atherosclerosis Study (ACAS) and the Asymptomatic Carotid Surgery Trial (ACST) in asymptomatic patients.2 3 4 5 However, this proved to be only a temporary respite because by the late 1990s, CEA was once again the subject of scrutiny following the emergence of carotid artery stenting (CAS) as a viable and less invasive alternative.6 However, despite initial optimism after Brown’s 1992 systematic review (30-day death/stroke rate after unprotected angioplasty without stenting was <1% in 123 pooled patients6), no fewer than 12 randomised controlled trials (RCTs)7 have subsequently failed to resolve the debate. The 2007 Cochrane review concluded that CAS conferred
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