Study Finds Long-Term Stroke and Death Rates Favor Carotid Endarterectomy (CEA) over Carotid Artery Stenting (CAS) in Treating Patients with Asymptomatic Carotid Artery Stenosis
BOSTON, MA, JUNE 13, 2026 – Today, the Society for Vascular Surgery (SVS) announced the findings of a new study demonstrating the safety and efficacy of emerging treatment options for patients with asymptomatic carotid stenosis (ACS).
Carotid stenosis occurs when plaque builds up in the carotid artery, narrowing the vessel and restricting blood flow to the brain and can lead to stroke. However, ACS occurs when the artery is narrowed by at least 70-80% without a recent stroke, significantly increasing the risk of future stroke, cardiovascular events, and cognitive decline. It is estimated that two million North Americans and Europeans live with treatable asymptomatic carotid artery stenosis (NIH).
In November 2025, the New England Journal of Medicine published data from the Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Study (CREST-2), focused on revascularization practices to manage stroke risk in ACS patients. SVS published an opinion piece on why CREST-2 trial results should inform, not replace, clinical judgement due to how the trial reflects idealized medical therapy, not routine clinical practice.
“Data presented at the Society for Vascular Surgery’s Vascular Annual Meeting underscores the importance of knowledge of which intervention, if any, is optimal for stroke management in patients with carotid disease,” said Keith D. Calligaro, MD, Chief, Vascular Surgery at Pennsylvania Hospital, President, Society for Vascular Surgery. “We should not disregard the findings of many past studies showing the benefit of carotid endarterectomy over carotid stenting in selected patients. The findings highlight the need for randomized clinical trials, real-world outcomes data, and the expertise of vascular surgeons, the only specialty that can perform trans-femoral carotid stenting, TCAR and CEA.”
Carotid Stenosis Patients Experience Improved Stroke and Mortality Outcomes Three Years After CEA than CAS
Using the TriNetX Collaborative US Network, a multi-institutional electronic health record platform continuously updating real-world data from healthcare organizations, researchers aim to compare perioperative and long-term outcomes of CEA and CAS in asymptomatic patients. Researchers selected adult patients with ACS who underwent CEA or CAS from the TriNetX Network. Patients were matched 1:1 using a propensity score match (PSM) to balance baseline characteristics like demographics, comorbidities, and relevant medications. The study’s primary outcomes included stroke, death, and the composite outcome of stroke or death at 30 days, one year, three years, and five years.
The study identified 101,714 patients in total, 61,124 of whom underwent CEA (60.1%) and 40,590 CAS (39.9%). Through PSM, 39,471 patients were matched to each cohort with balanced baseline characteristics. The CEA group showed consistently lower rates of stroke at 30 days (2.0% vs 2.4%, p=0.001), one year (2.9% vs 3.3%, p=0.001), three years (3.6% vs 3.9%, p=0.008), and five years (4.1% vs 4.4%, p=0.038). This group also saw significantly lower mortality rates at three years (11.8% vs 12.4%, p=0.014),though other time points reflected similar rates. At every time period stroke or death outcomes favored the CEA group, with significant differences observed at 30 days (3.9% vs 4.2%, p=0.049), one year (8.7% vs 9.4%, p=0.001), three years (14.9% vs 15.8%, p< 0.001), and five years (20.1% vs 20.8%, p=0.013).
“Our results suggest that CEA has more favorable stroke and mortality outcomes when patient demographics are equal,” said lead author Anthony H. Chau, MD, Associate Professor of Vascular and Endovascular Surgery, University of California, Irvine. “However, our findings do not conclude that every patient should undergo CEA. Instead, they remind us how paramount patient selection is when treating carotid artery stenosis, and the detail that should go into selecting the right procedure for the right patient.”
Session Details:
- “Carotid endarterectomy has improved long-term stroke and survival compared to carotid artery stenting in a real-world propensity-matched cohort analysis using the TriNetX Network”
- Saturday, June 13th from 9:04 am – 9:11 am ET (Plenary 7)
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About the Society for Vascular Surgery
The Society for Vascular Surgery® (SVS) seeks to advance excellence and innovation in vascular health through education, advocacy, research, and public awareness. The organization was founded in 1946 and currently has a membership of approximately 6,500. SVS membership is recognized in the vascular community as a mark of professional achievement. For more information, visit Vascular.org.
About VAM26
The Society for Vascular Surgery’s Vascular Annual Meeting (VAM) will be held in Boston, MA, on June 10-13. Leading physicians, researchers, and health care professionals in vascular surgery gather for three full days of groundbreaking educational content showcasing the latest data, research, and innovations in vascular surgery and vascular health. For more information, visit vam.vascular.org.
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