Trials and tribulations of carotid artery stenting: The Interventionalists' perspective on SAPPHIRE, EVA-3S, and SPACE Trials.

Three recently completed randomized studies of carotid artery stenting (CAS) versus endarterectomy-Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE), Endarterectomy versus Stenting in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S), and Stent-Supported Percutaneous Angioplasty of the Carotid Artery versus Endarterectomy (SPACE)-reached vividly different conclusions about the safety of stenting versus endarterectomy. The methodologies of these studies differed from each other in many respects. In an attempt to explain the disparate results of SAPPHIRE, EVA-3S, and SPACE, this focused review compares and contrasts these studies, with specific reference to inclusion and exclusion criteria, technical considerations, and the experience level of the interventional operators.