Update on Carotid Revascularization: Evidence from Large Clinical Trials

In the era of evidence-based medicine, doctors rely on clinical trials to guide their decisions. The best method of treating carotid stenosis is still debatable after six decades from the first carotid surgical revascularization performed. Despite the conduct and publication of dozens of trials on carotid revascularization, the truth remains shaggy. The interpretation of these trials is influenced by the design, inclusion criteria, credentialing of the operators and even their specialties. We will try to discuss the trials of carotid endarterectomy and carotid artery stenting trying to reach a conclusion of where is the truth regarding carotid revascularization. We will discuss the trials of CEA versus medical therapy, then the initials registries of CAS, then the trials that compared CEA against CAS, we will elaborate on the two techniques in peculiar situations and finally we will give a short notice about ongoing trials and future directions.