Randomized clinical trial comparing neurological outcomes after carotid endarterectomy or stenting

Background: Silent infarction in the brain can be detected in around 34 per cent of patients after carotid endarterectomy (CEA) and 54 per cent after carotid angioplasty and stenting (CAS). This study compared the risk of new infarctions in the brain in patients undergoing CEA or CAS. Methods: Consecutive patients with internal carotid artery (ICA) stenosis exceeding 70 per cent were screened for inclusion in this prospective study. Patients with indications for intervention, and eligible for bothmethods, were allocated randomly to CEA or CAS. Neurological examination, cognitive function tests and MRI of the brain were undertaken before and 24 h after intervention. Results: Of 150 randomized patients, 73 (47 men; mean age 64.9(7.1) years) underwent CEA and 77 (58 men; 66.4(7.5) years) had CAS. New infarctions on MRI were found more frequently after CAS (49 versus 25 per cent; P = 0.002). Lesion volume was also significantly greater after CAS (P = 0.010). Multiple logistic regression analyses identified intervention in the right ICA as the only independent predictor of brain infarction (odds ratio 2.10, 95 per cent c.i. 1.03 to 4.25; P = 0.040). Stroke or transient ischaemic attack occurred in one patient after CEA and in two after CAS. No significant differences were found in cognitive test results between the groups. Conclusion: These data confirm a higher risk of silent infarction in the brain on MRI after CAS in comparison with CEA, but without measurable change in cognitive function. Registration number: NCT01591005 (http://www.clinicaltrials.gov).