CEA and CAS Outcomes Compared in Real-World Study of Asymptomatic Carotid Stenosis

June 15, 2026—The Society for Vascular Surgery (SVS) announced findings from a new study showing lower long-term stroke and stroke or death rates with carotid endarterectomy (CEA) compared with carotid artery stenting (CAS) in patients with asymptomatic carotid stenosis.

The study was presented at VAM26, the SVS Vascular Annual Meeting 2026.

“Our results suggest that CEA has more favorable stroke and mortality outcomes when patient demographics are equal,” commented the study’s lead author Anthony H. Chau, MD, in the SVS press release. “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.”

According to SVS, the investigators used the TriNetX Collaborative United States Network to evaluate adult patients with asymptomatic carotid stenosis who underwent CEA or CAS. Patients were matched 1:1 by propensity score to balance demographics, comorbidities, and relevant medications. Primary outcomes were stroke, death, and the composite of stroke or death at 30 days and 1, 3, and 5 years.

The study was composed of 101,714 patients, of whom 61,124 underwent CEA (60.1%) and 40,590 underwent CAS (39.9%). After matching, 39,471 patients were included in each cohort, with balanced baseline characteristics, noted SVS.

As reported in the society’s press release, the study showed the following:

• Stroke rates were lower in the CEA group at 30 days (2.0% vs 2.4%; P = .001), 1 year (2.9% vs 3.3%; P = .001), 3 years (3.6% vs 3.9%; P = .008), and 5 years (4.1% vs 4.4%; P = .038).
• Mortality was significantly lower with CEA at 3 years (11.8% vs 12.4%; P = .014), although mortality rates were similar at other time points.
• The composite outcome of stroke or death also favored CEA at all reported intervals: 30 days (3.9% vs 4.2%; P = .049), 1 year (8.7% vs 9.4%; P = .001), 3 years (14.9% vs 15.8%; P < .001), and 5 years (20.1% vs 20.8%; P = .013).

SVS President Keith D. Calligaro, MD, stated in the press release, “Data presented at the SVS Vascular Annual Meeting underscore the importance of knowledge of which intervention, if any, is optimal for stroke management in patients with carotid disease.”

Dr. Calligaro continued, “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 transfemoral carotid stenting, transcarotid artery revascularization, and CEA.”