To the Editor: I read with interest the article by Hender and colleagues recently published in the Journal.1 I agree with the authors' conclusion that there is presently insufficient evidence to suggest the widespread use of endoluminal treatment for carotid artery disease. However, there are a number of problems with the authors' interpretation of our recent article comparing the outcome of surgical and endoluminal treatment of symptomatic carotid stenosis.2

Firstly, the figures in the Box are completely misleading. The percentages of adverse outcome quoted for patients undergoing endoluminal treatment are those that were found for cases receiving endarterectomy, while the figures quoted for endarterectomy are the findings for endoluminal treatment. [A correction of this error was published in the 3/17 December 2001 issue of the Journal, page 672.] Hence, any reader simply looking at the Box would be left with the false conclusion that the outcome of endoluminal treatment is superior.

Secondly, the authors refer to our article2 as a "meta-analysis". In our article we went to some trouble to explain that a meta-analysis was not possible, as only one small randomised trial had been published at that time. Instead, we had to use reports from single centres and we discussed the difficulties of comparing the results when patients had not been randomised.

Thirdly, the results of the CAVATAS trial were published in June 2001.3 A surprising finding was that the perioperative stroke rate (defined as a neurological deficit lasting seven days or more) for patients undergoing either carotid angioplasty (with or without stenting) or conventional endarterectomy was the same (around 10%). In fact, the disabling stroke rate of around 6% after either endovascular treatment or endarterectomy was three times higher than that found in the North American randomised trial of endarterectomy.4

Finally, the authors refer to our patients undergoing carotid stenting, whereas the majority of the patients referred to in fact received angioplasty alone.