The benefits and risks of endovascular treatment compared with carotid endarterectomy or medical therapy in patients with symptomatic or asymptomatic carotid stenosis. Search methods we searched the cochrane stroke group trials register (last searched january 2012) and the following databases: the cochrane central register of controlled trials (central) (the cochrane library 2010, issue 4), medline (1950 to january 2011), embase (1980 to january 2011) and science citation index (1945 to january 2011). We also searched ongoing trials registers (january 2011) and reference lists and contacted researchers in the field. Selection criteria randomised trials comparing endovascular treatment (including balloon angioplasty or stenting) with endarterectomy or medical therapy for symptomatic or asymptomatic atherosclerotic carotid stenosis. Data collection and analysis one review author selected trials for inclusion, assessed trial quality and extracted data. best viagra commercial ever A second review author independently validated trial selection and a third review author independently validated data extraction. We calculated treatment effects as odds ratios (or) and 95% confidence intervals (ci), with endovascular treatment as the reference group. We quantified heterogeneity using the i² statistic. Main results we included 16 trials involving 7572 patients. In patients with symptomatic carotid stenosis at standard surgical risk, endovascular treatment was associated with a higher risk of the following outcome measures occurring between randomisation and 30 days after treatment than endarterectomy: death or any stroke (the primary safety outcome) (or 1. 72, 95% ci 1. viagra no prescription 29 to 2. 31, p = 0. 0003; i² = 27%), death or any stroke or myocardial infarction (or 1. 44, 95% ci 1. is generic viagra available in australia 15 to 1. 80, p = 0. 002; i² = 7%), and any stroke (or 1. 81, 95% ci 1. 40 to 2. 34, p < 0. viagra canada online 00001; i² = 12%). The or for the primary safety outcome was 1. 16 (95% ci 0. best viagra commercial ever 80 to 1. buying viagra online australia 67) in patients < 70 years old and 2. order viagra online without script 20 (95% ci 1. ok use viagra without ed 47 to 3. 29) in patients ≥ 70 years old (interaction p = 0. 02). The rate of death or major or disabling stroke did not differ significantly between treatments (or 1. 28, 95% ci 0. 93 to 1. 77, p = 0. 13; i² = 0%). Endovascular treatment was associated with lower risks of myocardial infarction (or 0. 44, 95% ci 0. 23 to 0. viagra for sale 87, p = 0. 02; i² = 0%), cranial nerve palsy (or 0. cheap viagra 08, 95% ci 0. 05 to 0. 14, p < 0. buy viagra cheap 00001; i² = 0%) and access site haematomas (or 0. 37, 95% ci 0. 18 to 0. 77, p = 0. 008; i² = 27%). The combination of death or any stroke up to 30 days after treatment or ipsilateral stroke during fo. best viagra commercial ever