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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, . . .

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