Purpose: To compare carotid artery endarterectomy (CEA) to trans–femoral carotid artery stenting (F–CAS) and trans–cervical carotid artery stenting (C–CAS). Primary endpoints are stroke, myocardial infarction (MI) or death within 30 days after the procedure. Secondary endpoints included patency, re–intervention rates and 5–year stroke free survival.

Methods: Out of 9585 carotid patients referred, we performed 690 carotid interventions over 12 years. We matched 53 CEA and 53 CAS (34 F–CAS and 19 C–CAS) patients. Multiple logistic regressions were used to control for co–morbidity and anatomical high risk factors. Propensity scoring was used to adjust for baseline characteristics and selection bias, by matching co–variables.

Results: Our total 30–day stroke/death for 690 carotid interventions was 0.9%.  %. Thirty day stroke rate were 2.9%, 0% and 1.9% in the F–CAS, C–CAS and CEA respectably (P = .75). Thirty day MI was 0% in CAS group versus 1.9% in the CEA group (P = .32).Thirty–day mortality was 1.9% in CEA, 2.9% in F–CAS and 0% in C–CAS (P = .75). . 5–year stroke free survival was 94.3% in CEA, 97.1% in F–CAS and 100% in C–CAS (P = .55). 5–year restenosis–free rates were 97.7% in CEA, 100% in F–CAS and 88.2% in C–CAS (P = .01). 5–year re–intervention–free rates were 100% in CEA, 97.1% in F–CAS and 100% in C–CAS (P = .46).

Conclusion: C–CAS provides a safer option with significantly less risk of peri–operative stroke and combined postoperative stroke, MI and death.