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MC1: Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS)

  • Last modified date:
    8 February 2007

Professor Martin M Brown

Background

Percutaneous transluminal angioplasty and stenting (endovascular treatment) can be used to treat carotid and vertebral stenosis, but the risks and benefits were uncertain. We therefore compared endovascular treatment with conventional treatment in a multicentre international randomised trial.

Methods

560 patients were entered in three arms of the trial. Patients with carotid stenosis suitable for surgery were randomised between endovascular treatment and carotid surgery. Patients with carotid stenosis unsuitable for surgery (n=40) and patients with vertebral artery stenosis (n=16) were separately randomised between endovascular treatment and medical care alone. The number of patients in these last 2 groups was too small to form any firm conclusions. The analysis has therefore been restricted to the 504 patients with carotid stenosis randomised between endovascular treatment (n=251) or surgery (n=253). Stents were used in 55 (22%) randomised to endovascular treatment; the remainder were treated by balloon angioplasty alone. Patients were followed up by an independent neurologist. Analysis was by intention to treat.

Findings

The rates of major outcome events within 30 days of first treatment were not significantly different between endovascular treatment and surgery (6.4% vs. 5.9% respectively for disabling stroke or death; 10.0 vs. 9.9% for any stroke lasting 7 days or death). Cranial neuropathy was reported after surgery in 8.7%, but never after endovascular treatment (p0.0001). Major groin or neck haematoma occurred less often after endovascular treatment, compared with surgery (1.2% vs. 6.7%, p0.0015). One year after treatment, severe (70-99%) ipsilateral carotid stenosis was significantly more common after endovascular treatment (14.5% vs. 4.0%, p0.001). However, survival analysis up to 3 years after randomisation showed no significant difference in the rate of ipsilateral stroke (adjusted hazard ratio = 1.04, 95% confidence interval 0.63 to 1.70, p=0.9).

Interpretation

Endovascular treatment had similar major risks and effectiveness at preventing stroke over 3 years compared with carotid stenosis, but with wide confidence intervals. Endovascular treatment had the advantage of avoiding minor complications, but the greater rate of re-stenosis may result in more recurrent strokes in the longer term.

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