ABSTRACT
The relative high rate of procedural stroke in the surgical and endovascular groups in CAVATAS and the concern over stenting in the Leicester and Wallstent studies argues strongly against the general introduction of stenting as an alternative to surgery. Despite the encouraging findings of the meta-analysis, there remains uncertainty about the relative risks and benefits of endovascular treatment compared to surgery in patients suitable for either procedure. It seems reasonable that there should be a move away from simple balloon angioplasty towards stenting with cerebral protection. However, this endovascular technique requires further evaluation. The ongoing randomized trials of carotid stenting are justified on the basis that there is a definite reduction in minor morbidity in patients who undergo stenting compared to those who have surgery. Future trials need to provide more convincing data regarding the immediate major risks and the long-term benefits of stenting as well as the overall costs of the procedure compared to carotid endarterectomy.
