The carotid revascularization endarterectomy versus stenting trial (CREST): Stenting versus carotid endarterectomy for carotid disease

Vito A. Mantese, Carlos H. Timaran, David Chiu, Richard J. Begg, Thomas G. Brott

Research output: Contribution to journalArticle

229 Scopus citations

Abstract

BACKGROUND AND PURPOSE-: Carotid artery stenosis causes up to 10% of all ischemic strokes. Carotid endarterectomy (CEA) was introduced as a treatment to prevent stroke in the early 1950s. Carotid stenting (CAS) was introduced as a treatment to prevent stroke in 1994. METHODS-: The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) is a randomized trial with blinded end point adjudication. Symptomatic and asymptomatic patients were randomized to CAS or CEA. The primary end point was the composite of any stroke, myocardial infarction, or death during the periprocedural period and ipsilateral stroke thereafter, up to 4 years. RESULTS-: There was no significant difference in the rates of the primary end point between CAS and CEA (7.2% versus 6.8%; hazard ratio, 1.11; 95% CI, 0.81 to 1.51; P=0.51). Symptomatic status and sex did not modify the treatment effect, but an interaction with age and treatment was detected (P=0.02). Outcomes were slightly better after CAS for patients aged <70 years and better after CEA for patients aged >70 years. The periprocedural end point did not differ for CAS and CEA, but there were differences in the components, CAS versus CEA (stroke 4.1% versus 2.3%, P=0.012; and myocardial infarction 1.1% versus 2.3%, P=0.032). CONCLUSIONS-: In CREST, CAS and CEA had similar short- and longer-term outcomes. During the periprocedural period, there was higher risk of stroke with CAS and higher risk of myocardial infarction with CEA. CLINICAL TRIAL REGISTRATION-: www.clinicaltrials.gov. Unique identifier: NCT00004732.

Original languageEnglish (US)
Pages (from-to)S31-S34
JournalStroke
Volume41
Issue number10 SUPPL. 1
DOIs
StatePublished - Oct 1 2010

Keywords

  • carotid endarterectomy
  • carotid stenosis
  • randomized controlled trials
  • stenting
  • stroke care

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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