ABSTRACT
Limitations of the CAS vs. CEA Randomized Trials Current randomized data comparing CAS and CEA have several limitations. First of all, the data on asymptomatic patients are limited since all but one trial included only symptomatic patients. Second, the use of EPD was mandatory in just one trial (SAPPHIRE). Third, the minimal endovascular experience required per protocol was in most of the trials incredibly low and four of the five large randomized trials (i.e., enrolling over 300 patients) allowed endovascular treatment in the presence of a tutor for interventionalists with insufficient experience (Table 51.8). Other than SAPPHIRE, none of the randomized trials would have satisfied the minimum recommended endovascular experience according to a multispecialty CAS clinical competence statement (31).
