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N Engl J Med. 2010 Jul 1;363(1):11-23. doi: 10.1056/NEJMoa0912321. Epub 2010 May 26.

Stenting versus endarterectomy for treatment of carotid-artery stenosis.

Collaborators (170)

Clark W, Brooks W, Mackey A, Hill M, Buchan A, Leimgruber P, Mantese V, Timaran C, Hopkins LN, Chiu D, Begg R, Jamil Z, Hye R, Demaerschalk B, Brown OW, Roubin GS, Iyer S, Heck D, Farb R, Montanera W, Lee SK, Altafullah I, Ansel G, Sam A 2nd, Gonzales N, Campbell M, Choi J, Soukas P, Wechsler L, Clair D, Ouriel K, Reisman M, Gray W, Eidt J, Orlow S, Burke J, Sorenson S, Casterella PJ, Malas M, Murphy K, Rinaldi M, Rosenfield K, Sternbergh C 3rd, Felberg R, McCann R, Smith T, O'Mara C, Hakaim A, Katzen B, Spetzler R, Pucillo A, Elmore J, Jordan W, Lew D, Powell R, Bulas R, Kluck B, Rapp J, Mishkel G, Weaver F, Nazzal M, Narins C, Molnar R, Eskandari M, Aronow H, Shawl F, Rosenwasser R, Chastain H, Foster M, Raabe R, Pelz D, Stotts G, Cloft H, Heller L, Knopf W, Reddy B, Hodgson K, Fraser K, Gray W, Mohr JP, Shepard A, Reddy D, Montanera W, Moore W, Chaikof E, Stern B, Johnson S, Zelman R, Evans A, Burkart D, Bandyk D, Karanjia P, Zarghami J, Arthur A, Barr J, Mehta M, Comerota A, Natarajan K, Krol K, Howington J, Selchen D, Schermerhorn M, LoGerfo FW, Laster S, Sanz M, Lopez del Valle E, Andriole J, Ringer A, Martin J, Guzman R, Teal P, Hellinger F, Petrossian G, Berroya RB, Bates M, Mills J, Golden M, Fairman R, Mansour A, MacBeth A, Madyoon H, Iannone LA, Hansen K, Biller J, Shuck J, Gobin P, Dauterman K, Melton J, Benckart D, Lesley W, Belkin M, Bajwa T, Myla S, Snell J, Shownkeen H, Abou-Chebl A, Brott TG, Hobson RW 2nd, Beach KW, Cohen DJ, Cordell J, Cutlip DE, Ferguson RD, Hopkins LN, Howard G, Howard VJ, Keene L, Lal BK, Meschia JF, Mohr JP, Moore WS, Popma J, Roubin GS, Sheffet AJ, Silver FL, Cohen SN, Biller J, Broderick JP, Chaturvedi S, Kalafut MA, Skalabrin EJ, Blackshear JL, Glasser SP, Prineas RJ, Marsh J, Higashida R, Lamas G, Tilley B, Walker M, Cutter GR.

Author information

  • 1Mayo Clinic, Griffin 304, 4500 San Pablo Rd., Jacksonville, FL 32224, USA. brott.thomas@mayo.edu

Erratum in

  • N Engl J Med. 2010 Jul 29;363(5):498.
  • N Engl J Med. 2010 Jul 8;363(2):198.



Carotid-artery stenting and carotid endarterectomy are both options for treating carotid-artery stenosis, an important cause of stroke.


We randomly assigned patients with symptomatic or asymptomatic carotid stenosis to undergo carotid-artery stenting or carotid endarterectomy. The primary composite end point was stroke, myocardial infarction, or death from any cause during the periprocedural period or any ipsilateral stroke within 4 years after randomization.


For 2502 patients over a median follow-up period of 2.5 years, there was no significant difference in the estimated 4-year rates of the primary end point between the stenting group and the endarterectomy group (7.2% and 6.8%, respectively; hazard ratio with stenting, 1.11; 95% confidence interval, 0.81 to 1.51; P=0.51). There was no differential treatment effect with regard to the primary end point according to symptomatic status (P=0.84) or sex (P=0.34). The 4-year rate of stroke or death was 6.4% with stenting and 4.7% with endarterectomy (hazard ratio, 1.50; P=0.03); the rates among symptomatic patients were 8.0% and 6.4% (hazard ratio, 1.37; P=0.14), and the rates among asymptomatic patients were 4.5% and 2.7% (hazard ratio, 1.86; P=0.07), respectively. Periprocedural rates of individual components of the end points differed between the stenting group and the endarterectomy group: for death (0.7% vs. 0.3%, P=0.18), for stroke (4.1% vs. 2.3%, P=0.01), and for myocardial infarction (1.1% vs. 2.3%, P=0.03). After this period, the incidences of ipsilateral stroke with stenting and with endarterectomy were similarly low (2.0% and 2.4%, respectively; P=0.85).


Among patients with symptomatic or asymptomatic carotid stenosis, the risk of the composite primary outcome of stroke, myocardial infarction, or death did not differ significantly in the group undergoing carotid-artery stenting and the group undergoing carotid endarterectomy. During the periprocedural period, there was a higher risk of stroke with stenting and a higher risk of myocardial infarction with endarterectomy. (ClinicalTrials.gov number, NCT00004732.)

2010 Massachusetts Medical Society

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