In the group 65 to 69 years of age, the HR was 1.61 (95% CI, 0.90 2.88). In the group 70 to 74 years of age, the Recommendations for Extracranial Carotid Stenosis (Continued) COR LOE Recommendations CLINICAL STATEMENTS AND GUIDELINES Kleindorfer HR comparing CAS to CEA was 2.09 (95% CI, 1.32 3.32). This supports the recommendation for consid- ering patient age in the selection of the procedure. 6. In addition, CEA is associated with a reduced complication rate relative to CAS in patients who undergo the procedure within 1 week of a stroke or TIA. The Carotid Stenosis Trialists Collaboration evaluated 4138 patients randomly assigned to CEA or CAS.372 In patients who received the proce- dure within 1 week of the last symptomatic event, the stroke/death rate was 8.3% with CAS versus 1.3% with CEA (RR, 6.7; P=0.002). This supports a preference for CEA in patients who undergo early revascularization. 7. Post hoc analysis of these trials found a greater ben- efit of CEA when the surgery was done in patients who were enrolled within 2 weeks of their last non- disabling ischemic event.373 Therefore, if the patient is suitable for operation, early CEA is preferred. 8. In the SAPPHIRE trial (Stenting and Angioplasty With Protection in Patients at High Risk for Endarterectomy), patients with high anatomic or phys- iologic risk for CEA were assigned to CEA or CAS.374 The primary end point was stroke, MI, or death within 30 days or ipsilateral stroke up to 12 months. Among symptomatic patients, the primary end point occurred in 16.8% of patients undergoing CAS and 16.5% of patients undergoing CEA (P=0.95). However, the trial was not powered to evaluate only the symptom- atic group of patients. This study supports the option of CAS in patients at elevated surgical risk. 9. 