Halliday A, Bulbulia R, Bonati LH, et al. - After competent carotid artery stenting (CAS) and carotid endarterectomy (CEA), there were similar uncommon occurrences of serious complications and comparable long-term effects on fatal or disabling stroke.

• An international multicenter randomized trial, ACST-2, was conducted comparing CAS vs CEA among asymptomatic patients with severe stenosis.

• A total of 3,625 patients were randomly allocated to CAS or CEA.

• Disabling stroke or death occurred procedurally in 1% (15 allocated to CAS and 18 to CEA) and non-disabling procedural stroke occurred in 2% (48 allocated to CAS and 29 to CEA).

• Among asymptomatic and symptomatic patients, remarkably similar findings are recorded, with CEA slightly but non-significantly better than CAS, at least for non-disabling stroke.

• The ratio (CAS vs CEA) of long-term stroke incidence rates is 1·11.

• CAS and CEA had similar protective effects for at least the first few years.