Aortic & peripheral vascular diseaseRandomised controlled trial
Medical Management and Revascularization for Asymptomatic Carotid Stenosis
- Randomised controlled trial
- two parallel trials
- observer-blinded
- multicentre (155 centers, 5 countries)
Authors' conclusion
Among patients with high-grade stenosis without recent symptoms, the addition of stenting led to a lower risk of a composite of perioperative stroke or death or ipsilateral stroke within 4 years than intensive medical management alone. Carotid endarterectomy did not lead to a significant benefit.
Study context
- Population
- Patients with high-grade (≥70%) asymptomatic carotid stenosisstenting trial 1245
- Comparison
- Carotid stenting or endarterectomy plus intensive medical management vs intensive medical management alone
- Primary endpoint
- Any stroke or death from randomization to 44 days, or ipsilateral ischemic stroke during remaining follow-up
- Follow-up
- Up to 4 years
Primary result
As reported in the abstract
Primary outcome (4-year incidence)
Stenting vs Medical therapy (stenting trial): P = 0.02 · Endarterectomy vs Medical therapy (endarterectomy trial): P = 0.24
Further findings
| Outcome | Medical therapy (stenting trial) | Stenting | Medical therapy (endarterectomy trial) | Endarterectomy |
|---|---|---|---|---|
| Stroke or death, day 0 to 44 | ||||
| Strokes | Not reported in the abstract | 7 | 3 | 9 |
| Deaths | Not reported in the abstract | 1 | Not reported in the abstract | Not reported in the abstract |
Original publication
Medical Management and Revascularization for Asymptomatic Carotid Stenosis. N Engl J Med. Published 21 November 2025. doi:10.1056/nejmoa2508800
Summarised from the published abstract; every number is checked against it