More patients had stroke during follow-up in the endovascular group than in the surgical group, but the rate of ipsilateral non-perioperative stroke was low in both groups and none of the differences in the stroke outcome measures was significant. However, the study was underpowered and the confidence intervals were wide. More long-term data are needed from the on going stenting versus endarterectomy trials.

Naylor and colleagues1 draw attention to the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS). Their main criticism seems to arise from a supposition that patients in CAVATAS are selected for carotid angioplasty in such a way as to be “biasing the trial against carotid endarterectomy”. Angioplasty and surgery are different procedures, and it would be naive and dangerous to expect that every patient would be suitable for both. No surgeon would operate without reviewing the patient and their radiological findings to check suitability for surgery; the same conditions apply to angioplasty.