Key result
Transfemoral CAS linked to ~58% higher major event risk vs CEA in asymptomatic carotid stenosis.
Why the study?
Does transfemoral carotid artery stenting or transcarotid artery revascularization reduce the composite of stroke, death, or MI compared to carotid endarterectomy in veterans with asymptomatic carotid stenosis?
Cohort (n=11,922)
Yes
Does transfemoral carotid artery stenting or transcarotid artery revascularization reduce the composite of stroke, death, or MI compared to carotid endarterectomy in veterans with asymptomatic carotid stenosis?
Effect estimate: HR 1.58
Absolute Event Rate: 58.1% vs 42.7%
p-value: p=<.0001
In a nationwide cohort of veterans with asymptomatic carotid stenosis, transfemoral carotid artery stenting was associated with a higher long-term risk of stroke, death, or MI compared to carotid endarterectomy and transcarotid artery revascularization, which had comparable outcomes.
May warrant caution with transfemoral stenting in asymptomatic veterans; leaves open need for randomized confirmation.
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Green et al. (2026) conducted a cohort in Asymptomatic carotid stenosis (n=11,922). Transfemoral carotid artery stenting (TFCAS) vs. Carotid endarterectomy (CEA) and Transcarotid artery revascularization (TCAR) was evaluated on Composite of any stroke, death, or myocardial infarction (HR 1.58, p=<.0001).
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