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In patients with moderate-to-severe symptomatic carotid stenosis and recent ischemic events, guidelines consistently recommend carotid endarterectomy (CEA), but carotid angioplasty and stenting (CAS) is an increasingly popular alternative. However, a systematic review of five small randomized trials did not show a significant difference in outcomes between endarterectomy and stenting, and another recent trial, “EVA-3S,” was stopped early when an interim analysis showed significantly higher 30-day risk with stenting (Journal Watch Oct 18 2006).
In the “SPACE” trial, European researchers undertook a separate effort to establish whether CAS is noninferior to CEA. They randomized 1183 patients — all with onset of neurologic or ocular symptoms wi…