Stroke and death rates similar in stenosis patients undergoing stenting or endarterectomy

**Silver F. Stroke.2011;42:675-680.**

Issue: April 2011

Researchers have found no significant difference in stroke and death rates in patients with carotid stenosis treated with carotid artery stenting or with carotid endarterectomy; however, periprocedural stoke and death rates were much lower in symptomatic patients who received stents.

The Carotid Revascularization Endarterectomy Vs. Stenting Trial (CREST) was a randomized endpoint trial that compared the safety and efficacy of carotid artery stenting (CAS) vs. carotid endarterectomy (CEA) in patients with high-grade carotid stenosis. The study was supported by the National Institute of Neurological Disorders and Stroke and the NIH, with additional funding from Abbott Vascular Solutions Inc.

Patients were defined as symptomatic if they exhibited relative symptoms up to 180 days of randomization. A total of 1,321 symptomatic patients and 1,181 asymptomatic patients were enrolled at 117 sites throughout the United States and Canada. The primary endpoint included stroke, MI, death within the periprocedural period or ipsilateral stroke within 4 years.

Operators included surgeons who performed 12 or more CEAs per year; interventionalists were experienced in CAS and received hands-on training using the stenting and embolic-protection devices being observed in the study.

In both arms, the periprocedural aggregate of stroke, MI and death were similar (5.2% vs. 4.5%; HR=1.18; 95% CI, 0.82-1.68). The stroke and death rate was higher for CAS than for CEA (4.4% vs. 2.3%; HR=1.90; 95% CI, 1.21-2.98). For symptomatic patients, the periprocedural stroke and death rates were 6 ± 0.9% for CAS and 3.2 ± 0.7% for CEA (HR=1.89; 95% CI, 1.11-3.21). For asymptomatic patients, stroke and death rates were 2.5 ± 0.6% for CAS and 1.4 ± 0.5% for CEA (HR=1.88; 95% CI, 0.79-4.42). Rates were lower in patients aged younger than 80 years.

“CREST has demonstrated that, with experienced surgeons and interventionalists, both CEA and CAS are viable options for carotid revascularization because the overall complication rates for both procedures are within current treatment guidelines,” researchers wrote.

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