Carotid stenting has the advantage over endarterectomy of avoiding the complications of neck incision, and often of general anaesthesia too, but it has not yet been shown convincingly to be either as safe or as effective. Only randomised controlled trials allow proper comparison of these aspects of stenting and endarterectomy, but the results to date have been contradictory. Some trials have shown similar 30-day risks of stroke or death, while others have been stopped early because of significantly worse outcome in the stenting group. Inclusion of investigators with limited experience of carotid stenting devices may have contributed to poor results in some trials. The published trials are rather heterogeneous, none is large enough to provide convincing data, and there is very limited long-term follow-up information. We therefore need more data from the ongoing randomised trials before recommending that stenting should in general replace endarterectomy for either symptomatic or asymptomatic carotid stenosis.
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Competing interests: MMB is the Principal Investigator of the ICSS trial and the Editor of Practical Neurology is chairman of our Data Monitoring Committee.