Batchelder AJ, et al. - Primary and secondary analyses of 20 randomized controlled trials comparing carotid endarterectomy (CEA) with carotid artery stenting (CAS) were performed. Outcomes revealed that CAS vs CEA confers higher rates of 30-day death/stroke. After 30 days, CEA and CAS were virtually identical for ipsilateral stroke. Better case selection may reduce procedural death/stroke following CAS; this includes conducting CEA in (i) symptomatic patients aged > 70 years; (ii) interventions within 14 days of symptom onset; and (iii) situations where stroke risk after CAS is predicted to be higher (segmental/remote plaques, plaque length > 13 mm, heavy burden of white matter lesions [WMLs], where two or more stents might be needed). Following CAS, new WMLs were significantly more frequently encountered (52% vs 17%) which were correlated with higher rates of late stroke/transient ischaemic attack (23% vs 9%); however, no evidence indicated a predisposition towards late cognitive impairment with the emergence of new WMLs. After CAS, researchers observed a common occurrence of restenoses (10%) but these did not raise late ipsilateral stroke. They noted an association of restenoses (70%–99%) after CEA with a small but significant increase in late ipsilateral stroke.