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[Comment] Age and carotid intervention outcomes

In The Lancet, the Carotid Stenting Trialists’ Collaboration (CSTC) present a meta-analysis of the effect of increasing age on perioperative death or stroke related and late ipsilateral stroke in 4754 symptomatic patients randomised to carotid endarterectomy (CEA) or carotid artery stenting (CAS) in three European randomised controlled trials (RCTs; EVA-3S, SPACE, and ICSS) and one North American RCT (CREST).1 Key findings were that once the perioperative period (between randomisation and 120 days) passed, there was no difference in late ipsilateral stroke between CEA and CAS, irrespective of age, and that increasing age had no effect on procedural risks after CEA, but there was a stepwise increase in perioperative stroke or death after CAS, contributing to the CAS versus CEA treatment difference, which became apparent at 65–69 years of age (hazard ratio 1·81, 95% CI 0·97–3·38) and most pronounced over the age of 70 (2·28, 1·39–3·75).