Carotid artery stenting: a systematic review of randomized clinical trials.

Carotid occlusive disease is responsible for a significant proportion of major adverse cardiovascular events (death, stroke, myocardial infarction). Effective prevention by means of revascularization is a sufficient treatment, if performed at a center with an acceptably low procedural complication rate. Carotid surgery is the currently accepted standard of treatment for revascularization of extra cranial carotid occlusive disease. This has been validated by randomized clinical trials that have demonstrated its efficacy over best medical therapy. However, less invasive protected carotid artery stenting (CAS) has emerged as a potential therapeutic alternative to carotid endarterectomy (CEA) for the treatment of carotid atherosclerotic disease. Over the past decade several clinical trials have compared endovascular with surgical treatment. The Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) trial favored stenting over surgery in high-risk patients. The effectiveness of endovascular treatment in low-risk patients and patients with asymptomatic stenoses at preventing of stroke is still uncertain. Carotid artery stenting with an embolic protection device cannot be considered a scientifically sound and evidence-based alternative to carotid surgery in low-risk and asymptomatic patients until we have the results of further randomized trials. This overview presents the currently available data from randomized trials.