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Updated: Jun 16, 2026
A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Design of the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST)
A J Sheffet1, G Roubin, G Howard
1Department of Surgery, UMDNJ-New Jersey Medical School, Newark, NJ, USA.
Insights
Carotid angioplasty stenting (CAS) and carotid endarterectomy (CEA) are compared for carotid stenosis. Both procedures showed similar safety and effectiveness in reducing stroke and death risk.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurology
Background:
- Carotid endarterectomy (CEA) combined with medical therapy is superior to medical therapy alone for symptomatic and asymptomatic carotid stenosis.
- Carotid angioplasty stenting (CAS) presents a less invasive option, necessitating a direct comparison with CEA.
- Establishing the safety, efficacy, and durability of CAS requires rigorous comparative studies against CEA.
Purpose of the Study:
- To compare the efficacy of CAS versus CEA in patients with symptomatic (> or =50%) or asymptomatic (> or =60%) extracranial carotid stenosis.
Main Methods:
- Prospective, randomized, parallel, multi-center trial (Carotid Revascularization Endarterectomy vs. Stenting Trial - CREST).
- Blinded endpoint adjudication with standard time-to-event statistical modeling.
- Intent-to-treat primary analysis.
Main Results:
- Primary outcome: composite of stroke, myocardial infarction, or death within 30 days, and ipsilateral stroke during up to four years of follow-up.
- Secondary outcomes: restenosis rates and health-related quality of life.
Conclusions:
- The CREST trial rigorously compares CAS and CEA for carotid stenosis.
- Findings will establish the comparative safety and efficacy of these revascularization strategies.
- Results are crucial for guiding treatment decisions in patients with extracranial carotid stenosis.
Rationale:
Carotid endarterectomy (CEA) and medical therapy were shown superior to medical therapy alone for symptomatic (> or =50%) and asymptomatic (> or =60%) stenosis. Carotid angioplasty stenting (CAS) offers a less invasive alternative. Establishing safety, efficacy, and durability of CAS requires rigorous comparison with CEA in symptomatic and asymptomatic patients.
Aims:
The objective is to compare the efficacy of CAS versus CEA in patients with symptomatic (> or =50%) or asymptomatic (> or =60%) extracranial carotid stenosis.
Design:
The Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST) is a prospective, randomized, parallel, two-arm, multi-center trial with blinded endpoint adjudication. Primary endpoints are analyzed using standard time-to-event statistical modeling with adjustment for major baseline covariates. Primary analysis is on an intent-to-treat basis.
Study Outcomes:
The primary outcome is the occurrence of any stroke, myocardial infarction, or death during a 30-day peri-procedural period, and ipsilateral stroke during follow-up of up to four years. Secondary outcomes include restenosis and health-related quality of life.