Another nail in the coffin of carotid endarterectomy.

The randomized carotid stent versus carotid surgery trial reported by Brooks et al. (1) in this issue of the Journal is a notable accomplishment in several respects. By reporting results in 104 patients, it becomes the largest randomized carotid artery stent versus carotid endarterectomy trial published to date (to my knowledge). It is also an excellent example of team building with a surgeon, a cardiologist and a neurologist working together to optimize patient care. The authors are to be congratulated on conducting a randomized trial with prospective independent neurology oversight. The trial, as do all clinical trials, has strengths and weaknesses. The strengths include reasonably good methodology with routine preprocedural and postprocedural objective patient assessment by a neurologist and carotid duplex ultrasound scans within 24 h of the procedure and serially thereafter. Magnetic resonance imaging was performed at 6 and 12 months after the procedure to detect asymptomatic cerebrovascular ischemic events.