Table 4.
Longer-term outcomes with CAS compared to CEA in the largest randomized trials of symptomatic and/or asymptomatic patients.
| Randomized trial | n, symptomatic status | Follow-up (years) |
Outcome measure (%) CAS vs. CEA |
CAS excess: HR/OR & 95% CI | P | |
|---|---|---|---|---|---|---|
| 30-Day peri-procedural stroke/death or later ipsilateral stroke | ||||||
| CREST-1, 2010 (65) | 2,502 SPts + APts | 4 by KMA (median 2.5) | 6.2 | 4.7 | HR 1.44 (1.00–2.06) | 0.049 |
| CREST-1, 2010 (65) | 1,181 APts | 4 by KMA (median 2.5) | 4.5 | 2.7 | HR 1.86 (0.95–3.66) | 0.07 |
| CREST-1, 2010 (65) | 1,321 SPts | 4 by KMA (median 2.5) | 8.0 | 6.4 | HR 1.37 (0.90–2.09) | 0.14 |
| ICSS, 2015 (77) | 1,710 SPts | 5 by KMA (median 4.2) | 11.8 | 7.2 | HR 1.72 (1.24–2.39) | <0.01 |
| SPACE-1, 2008 (78) | 1,214 SPts | 2 by KMA | 9.5 | 8.8 | HR 1.10 (0.75–1.61) | 0.62 |
| EVA-3S, 2008 (79) | 527 SPts | 4 by KMA (median 3.5) | 11.1 | 6.2 | HR 1.97 (1.06–3.67) | 0.03 |
| 30-Day peri-procedural death or any stroke | ||||||
| ACST-2 (68)∧ | 3,625 APts | 5 mean | 8.6 | 7.1 | OR 1.23 (0.96–1.59)* | 0.09 |
| CREST-1, 2016 (80) | 1,607 SPts + APts | 10 by KMA (7.4 median) | 11.0 | 7.9 | HR 1.37 (1.01–1.86) | 0.04 |
| CAVATAS, 2009# (81) | 504 SPts + APts | 8 KMA (median 5) | 29.7 | 23.5 | HR 1.35 (0.94–1.93)* | 0.10 |
| Any stroke free survival # | ||||||
| ACT-1, 2016 (69) | 1,453 APts | 5 by KMA (median/mean not published) | 93.1 | 94.7 | Insufficient raw data published to calculate HR/OR | |
KMA, Kaplan Meier analysis; SPts, symptomatic patients with advanced ipsilateral carotid stenosis; APts, patients with advanced asymptomatic or recently (for at least 6 months) asymptomatic carotid stenosis.
Bolded font indicates trials with sufficient statistical power to compare longer term stroke and death rate with CEA and CAS (including and beyond the peri-procedural period).
#90% were symptomatic.
*OR calculated from published raw data.
∧Analysis using intention to treat figures.
#These figures on any stroke free survival in ACT-1 appear to exclude 30-day peri-procedural strokes (69).