CREST
Trial question
What is the role of carotid artery stenting in patients with symptomatic or asymptomatic stenosis?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
35.0% female
65.0% male
N = 2502
2502 patients (872 female, 1630 male)
Inclusion criteria: patients with symptomatic or asymptomatic carotid stenosis
Key exclusion criteria: previous stroke sufficiently severe to confound the assessment of end points, chronic AF, paroxysmal AF that had occurred within the preceding 6 months or that necessitated anticoagulation therapy, myocardial infarction within the previous 30 days, or unstable angina
Interventions
N=1271 carotid artery stenting (RX Acculink stent and, whenever feasible, the RX Accunet embolic-protection device plus antiplatelet therapy with aspirin and clopidogrel)
N=1251 carotid endarterectomy (carotid endarterectomy plus antiplatelet therapy with aspirin)
Primary outcome
Stroke, myocardial infarction, or death from any cause during periprocedural period, or any ipsilateral stroke at 4 years
7.2
6.8
7.2 %
5.4 %
3.6 %
1.8 %
0.0 %
Carotid artery
stenting
Carotid
endarterectomy
No significant
difference ↔
No significant difference in stroke, myocardial infarction, or death from any cause during the periprocedural period, or any ipsilateral stroke at 4 years (7.2% vs. 6.8%; HR 1.11, 95% CI 0.81 to 1.51)
Secondary outcomes
Significant increase in stroke or death at 4 years (6.4% vs. 4.7%; HR 1.5, 95% CI 1.05 to 2.15)
Significant decrease in myocardial infarction (1.1% vs. 2.3%; HR 0.5, 95% CI 0.26 to 0.94)
Conclusion
In patients with symptomatic or asymptomatic carotid stenosis, carotid artery stenting was not superior to carotid endarterectomy with respect to stroke, myocardial infarction, or death from any cause during the periprocedural period, or any ipsilateral stroke at 4 years.
Reference
Brott TG, Hobson RW nd, Howard G et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med. 2010 Jul 1;363(1):11-23.
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