A single-center, prospective, randomized controlled study in Germany showed that carotid endarterectomy has significantly better long-term follow-up than carotid stenting Dr. Steinbauer MG of the Department of Vascular and Endovascular Surgery, University of Regensburg, Germany, published the results of his single-center, prospective, randomized controlled study in the July 2008 issue of the American Journal of Vascular Surgery (J Vasc Surg. 2008 Jul;48(1):93-8. :93-8.) published the results of his single-center, prospective, randomized, controlled study that carotid endarterectomy (CEA) has significantly better long-term follow-up outcomes than carotid stenting (CAS). The efficacy of carotid endarterectomy (CEA) for the prevention of stroke in symptomatic and asymptomatic carotid stenosis has been proven for more than 50 years. Although some prospective randomized controlled studies have shown carotid stenting (CAS) to be another option, none have so far shown superior results to CEA. Long-term follow-up results comparing CEA and CAS are particularly lacking. In this study, we performed a prospective randomized controlled study of CEA and CAS in 87 symptomatic patients with high internal carotid artery stenosis (>70%) treated at our center from August 1999 to April 2002. 66 +/- 14.2 months mean follow-up in the CAS group and 64 +/- 12.1 months mean follow-up in the CEA group, with clinical evaluation and documentation of neurologically relevant events in both groups. Sixty-one patients (29 CEA, 32 CAS) underwent ultrasound Doppler examination and angiography in patients with >70% restenosis. The results showed that 23 patients (25.2%) died during the follow-up period (13 CEA, 10 CAS) and 3 were lost to follow-up. The incidence of stroke during follow-up was significantly higher in CAS patients than in CEA patients: 4 of 42 (9.5%) CAS patients had a stroke, while none of the 42 CEA patients had a stroke. Transient cerebral ischemia occurred in one patient in each group. the rate of restenosis above 70% was significantly higher in the CAS group (18.8%, 6/32) than in the CEA group (0%, 0/29). five of the 32 CAS patients (15.6%) had high restenosis above 70% requiring reintervention or surgical removal of the stent, and three of them had neurological symptoms. None of the patients treated with CEA required reintervention (P < .05 vs CAS). 8 of 32 (25%) of 32 CAS and 1 of 29 (3.4%) of 29 CEA had moderate restenosis below 70%. High contralateral carotid stenosis was treated in 5 of 32 (15.6%) patients with CAS and in 3 of 29 (10.3%) patients with CEA during follow-up. The long-term follow-up results of our prospective randomized controlled study showed that the incidence of restenosis and neurological complications after CAS was significantly higher in the CAS group than in the CEA group, and that CEA was superior to CAS in the prevention of restenosis and stroke; however, the results of the ongoing multicenter long-term follow-up will be more conclusive.