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CREST: CAS, CEA performed by vascular surgeons led to similar outcomes
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Carotid artery stenting and carotid endarterectomy produce comparable net outcomes when performed by appropriately trained vascular surgeons, according to data presented at the 65th Vascular Annual Meeting of the Society for Vascular Surgery.
Researchers examined the results of carotid endarterectomy (CAS; n=765) and carotid artery stenting (CAS; n=237) performed by vascular surgeons among 2,320 patients of the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST) who received their assigned treatment. The primary endpoint was a composite of periprocedural stroke, MI or death.
At 4 years, the researchers reported that the primary endpoint did not differ between CAS (6.2%) and CEA (5.6%; P=.41 for trend) procedures that were performed by vascular surgeons. Among these patients, rates of death and stroke were higher after CAS compared with CEA for symptomatic patients (6.1% vs. 1.3%; P=.01) but not asymptomatic patients (2.6% vs. 1.1%; P=.20), whereas rates of MI (2.6% vs. 1.3%; P=.30) and cranial nerve injuries (5% vs. 0%) were both higher in CEA patients.
Additionally, once age, sex and symptomatic status were adjusted for, outcomes regarding the primary endpoint at 4 years were similar between vascular surgeons and interventionalists (HR=1.11; 95% CI, 0.81-1.51).
“Trained vascular surgeons may safely offer both CEA and CAS for the prevention of stroke,” the researchers concluded in their abstract. “As for all interventionalists/operators, focus on preventing periprocedural events is of high priority for vascular surgeons.”
Previous Cardiology Today coverage of the CREST trial can be viewed here.
For more information:
- Timaran CH. LB6. Presented at: 2011 Vascular Annual Meeting; June 16-18, 2011; Chicago.
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