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Duration of asymptomatic status and outcomes following carotid endarterectomy and carotid artery stenting in the Carotid Revascularization Endarterectomy vs Stenting Trial.
J Vasc Surg. 2019 06; 69(6):1797-1800.JV

Abstract

BACKGROUND

Most carotid revascularization studies define asymptomatic as symptom-free for more than 180 days; however, it is unknown if intervention carries similar risk among those currently asymptomatic but with previous symptoms (PS) vs those who were always asymptomatic (AA).

METHODS

We compared the periprocedural and 4-year risks of PS vs AA patients in the Carotid Revascularization Endarterectomy vs Stenting Trial (CREST) randomized to carotid endarterectomy (CEA) or carotid artery stenting (CAS)/angioplasty. Proportional hazards models adjusting for age, sex, and treatment were used to assess the risk of periprocedural stroke and/or death (S+D; any S+D during periprocedural period), stroke and death at 4 years (any S+D within the periprocedural period and ipsilateral stroke out to 4 years) and the primary end point at 4 years (any stroke, death, and myocardial infarction within the periprocedural period and ipsilateral stroke out to 4 years). Analysis was performed pooling the CEA-treated and CAS-treated patients, and separately for each treatment.

RESULTS

Of 1181 asymptomatic patients randomized in CREST, 1104 (93%) were AA and 77 (7%) were PS. There was no difference in risk when comparing the AA and PS cohorts in the pooled CAS+CEA population for periprocedural S+D (2.0% vs 1.3%), S+D at 4 years (3.6% vs 3.2%), or the primary end point (5.2% vs 5.8%). There were also no differences among those assigned to CEA (periprocedural S+D, 1.5% vs 0%; S+D at 4 years, 2.7% vs 0%; or primary end point, 5.1% vs 2.4%) or CAS (periprocedural S+D, 2.5% vs 2.8%; S+D at 4 years, 4.4% vs 6.9%; or primary end point, 5.3% vs 9.8%) when analyzed separately.

CONCLUSIONS

In CREST, only a small minority of asymptomatic patients had previous ipsilateral symptoms. The outcomes of periprocedural S+D, periprocedural S+D, and ipsilateral stroke up to 4 years, and the primary end point did not differ for AA patients compared with PS patients.

Authors+Show Affiliations

Division of Vascular Surgery, UCLA Medical Center, Los Angeles, Calif.Department of Neurology, Medical University of South Carolina, Charleston, SC.Cardiovascular Associates of the Southeast, Birmingham, Ala.Department of Neurology, Oregon Health and Sciences University, Portland, Ore.Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Ala.Cardiology Associates, Central Baptist Hospital, Lexington, Ky.Department of Neurology, Mayo Clinic, Jacksonville, Fla; Department of Surgery, New Jersey Medical School, Rutgers University, The State University of New Jersey, Newark, NJ. Electronic address: brott.thomas@mayo.edu.No affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

30630649

Citation

Moore, Wesley S., et al. "Duration of Asymptomatic Status and Outcomes Following Carotid Endarterectomy and Carotid Artery Stenting in the Carotid Revascularization Endarterectomy Vs Stenting Trial." Journal of Vascular Surgery, vol. 69, no. 6, 2019, pp. 1797-1800.
Moore WS, Voeks JH, Roubin GS, et al. Duration of asymptomatic status and outcomes following carotid endarterectomy and carotid artery stenting in the Carotid Revascularization Endarterectomy vs Stenting Trial. J Vasc Surg. 2019;69(6):1797-1800.
Moore, W. S., Voeks, J. H., Roubin, G. S., Clark, W. M., Howard, V. J., Jones, M. R., & Brott, T. G. (2019). Duration of asymptomatic status and outcomes following carotid endarterectomy and carotid artery stenting in the Carotid Revascularization Endarterectomy vs Stenting Trial. Journal of Vascular Surgery, 69(6), 1797-1800. https://doi.org/10.1016/j.jvs.2018.09.054
Moore WS, et al. Duration of Asymptomatic Status and Outcomes Following Carotid Endarterectomy and Carotid Artery Stenting in the Carotid Revascularization Endarterectomy Vs Stenting Trial. J Vasc Surg. 2019;69(6):1797-1800. PubMed PMID: 30630649.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Duration of asymptomatic status and outcomes following carotid endarterectomy and carotid artery stenting in the Carotid Revascularization Endarterectomy vs Stenting Trial. AU - Moore,Wesley S, AU - Voeks,Jenifer H, AU - Roubin,Gary S, AU - Clark,Wayne M, AU - Howard,Virginia J, AU - Jones,Michael R, AU - Brott,Thomas G, AU - ,, Y1 - 2019/01/08/ PY - 2018/01/17/received PY - 2018/09/05/accepted PY - 2020/06/01/pmc-release PY - 2019/1/12/pubmed PY - 2019/11/19/medline PY - 2019/1/12/entrez KW - Asymptomatic patients KW - Carotid stenosis KW - Prior symptoms in asymptomatic patients SP - 1797 EP - 1800 JF - Journal of vascular surgery JO - J. Vasc. Surg. VL - 69 IS - 6 N2 - BACKGROUND: Most carotid revascularization studies define asymptomatic as symptom-free for more than 180 days; however, it is unknown if intervention carries similar risk among those currently asymptomatic but with previous symptoms (PS) vs those who were always asymptomatic (AA). METHODS: We compared the periprocedural and 4-year risks of PS vs AA patients in the Carotid Revascularization Endarterectomy vs Stenting Trial (CREST) randomized to carotid endarterectomy (CEA) or carotid artery stenting (CAS)/angioplasty. Proportional hazards models adjusting for age, sex, and treatment were used to assess the risk of periprocedural stroke and/or death (S+D; any S+D during periprocedural period), stroke and death at 4 years (any S+D within the periprocedural period and ipsilateral stroke out to 4 years) and the primary end point at 4 years (any stroke, death, and myocardial infarction within the periprocedural period and ipsilateral stroke out to 4 years). Analysis was performed pooling the CEA-treated and CAS-treated patients, and separately for each treatment. RESULTS: Of 1181 asymptomatic patients randomized in CREST, 1104 (93%) were AA and 77 (7%) were PS. There was no difference in risk when comparing the AA and PS cohorts in the pooled CAS+CEA population for periprocedural S+D (2.0% vs 1.3%), S+D at 4 years (3.6% vs 3.2%), or the primary end point (5.2% vs 5.8%). There were also no differences among those assigned to CEA (periprocedural S+D, 1.5% vs 0%; S+D at 4 years, 2.7% vs 0%; or primary end point, 5.1% vs 2.4%) or CAS (periprocedural S+D, 2.5% vs 2.8%; S+D at 4 years, 4.4% vs 6.9%; or primary end point, 5.3% vs 9.8%) when analyzed separately. CONCLUSIONS: In CREST, only a small minority of asymptomatic patients had previous ipsilateral symptoms. The outcomes of periprocedural S+D, periprocedural S+D, and ipsilateral stroke up to 4 years, and the primary end point did not differ for AA patients compared with PS patients. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/30630649/Duration_of_asymptomatic_status_and_outcomes_following_carotid_endarterectomy_and_carotid_artery_stenting_in_the_Carotid_Revascularization_Endarterectomy_vs_Stenting_Trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(18)32468-6 DB - PRIME DP - Unbound Medicine ER -