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The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST): stenting versus carotid endarterectomy for carotid disease.
Stroke. 2010 Oct; 41(10 Suppl):S31-4.S

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.

Authors+Show Affiliations

Mayo Clinic, Griffin 3rd Floor, 4500 San Pablo Road, Jacksonville, FL 32224. brott.thomas@mayo.edu.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

20876500

Citation

Mantese, Vito A., et al. "The Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST): Stenting Versus Carotid Endarterectomy for Carotid Disease." Stroke, vol. 41, no. 10 Suppl, 2010, pp. S31-4.
Mantese VA, Timaran CH, Chiu D, et al. The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST): stenting versus carotid endarterectomy for carotid disease. Stroke. 2010;41(10 Suppl):S31-4.
Mantese, V. A., Timaran, C. H., Chiu, D., Begg, R. J., & Brott, T. G. (2010). The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST): stenting versus carotid endarterectomy for carotid disease. Stroke, 41(10 Suppl), S31-4. https://doi.org/10.1161/STROKEAHA.110.595330
Mantese VA, et al. The Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST): Stenting Versus Carotid Endarterectomy for Carotid Disease. Stroke. 2010;41(10 Suppl):S31-4. PubMed PMID: 20876500.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST): stenting versus carotid endarterectomy for carotid disease. AU - Mantese,Vito A, AU - Timaran,Carlos H, AU - Chiu,David, AU - Begg,Richard J, AU - Brott,Thomas G, AU - ,, PY - 2010/9/30/entrez PY - 2010/10/13/pubmed PY - 2010/11/3/medline SP - S31 EP - 4 JF - Stroke JO - Stroke VL - 41 IS - 10 Suppl N2 - 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. SN - 1524-4628 UR - https://www.unboundmedicine.com/medline/citation/20876500/The_Carotid_Revascularization_Endarterectomy_versus_Stenting_Trial__CREST_:_stenting_versus_carotid_endarterectomy_for_carotid_disease_ L2 - http://www.ahajournals.org/doi/full/10.1161/STROKEAHA.110.595330?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -