Long-Term Follow-Up Study of Endarterectomy Versus Angioplasty in Patients With Symptomatic Severe

Landmark studies have shown that carotid endarterec-tomy is effective in reducing the risk of stroke in patients with severe symptomatic carotid stenosis.1 Compared with endarterectomy, carotid stenting has been associated with a higher risk of procedural stroke or death,2–7 a difference mainly driven by nondisabling strokes.6 In the first few years Background and Purpose—We aimed at comparing the long-term benefit–risk balance of carotid stenting versus endarterectomy for symptomatic carotid stenosis. Methods—Long-term follow-up study of patients included in Endarterectomy Versus Angioplasty in Patients With Symptomatic Severe Carotid Stenosis (EVA-3S), a randomized, controlled trial of carotid stenting versus endarterectomy in 527 patients with recently symptomatic severe carotid stenosis, conducted in 30 centers in France. The main end point was a composite of any ipsilateral stroke after randomization or any procedural stroke or death. Results—During a median follow-up of 7.1 years (interquartile range, 5.1–8.8 years; maximum 12.4 years), the primary end point occurred in 30 patients in the stenting group compared with 18 patients in the endarterectomy group. Cumulative probabilities of this outcome were 11.0 % (95 % confidence interval, 7.9–15.2) versus 6.3 % (4.0–9.8) in the endarterectomy group at the 5-year follow-up (hazard ratio, 1.85; 1.00–3.40; P=0.04) and 11.5 % (8.2–15.9) versus 7.6 % (4.9–11.8