Stenting versus Surgery for Carotid Stenosis

To the Editor: Rosenfield et al. (March 17 issue)¹ report that in the Asymptomatic Carotid Trial (ACT) I, carotid-artery stenting with embolic protection was noninferior to carotid endarterectomy in asymptomatic patients. Similar results were reported by Brott et al. (March 17 issue)² for the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST), although only 47.2% of the patients in that trial were asymptomatic. However, we feel that some aspects of ACT I merit further discussion.The authors have acknowledged the prolonged enrollment period (2005 to 2013) and early termination of ACT I as a limitation of the trial. During this period, . . .