Halliday A, Bulbulia R, Bonati LH, et al. - Comparing carotid artery stenting (CAS) vs carotid endarterectomy (CEA) in asymptomatic patients with severe carotid artery stenosis, it was found that serious complications were similarly uncommon following competent CAS and CEA. Also, findings demonstrated comparable long-term impacts of these two carotid artery procedures on fatal or disabling stroke.

• This international multicentre randomised trial (ACST-2) included 3625 asymptomatic patients with severe stenosis thought to need intervention.

• Patients were randomized, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up.

• Procedural disabling stroke or death occurred in 1% (15 allocated to CAS and 18 to CEA), and 2% were found to have non-disabling procedural stroke (48 allocated to CAS and 29 to CEA).

• In each group, estimates of 5-year non-procedural stroke were 2·5% for fatal or disabling stroke, and estimates were 5·3% with CAS vs 4·5% with CEA for any stroke (rate ratio [RR] 1·16).

• Taking together RRs for any non-procedural stroke in all CAS vs CEA trials, similar RR was reported in symptomatic and asymptomatic patients (overall RR 1·11).