Carotid stenting vs surgery: parsing the risk of stroke and MI
Olcay Aksoy1, Samir R Kapadia, Christopher Bajzer
1Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH 44195, USA.
Insights
The Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST) found carotid artery stenting and surgery to be equally safe and effective for preventing stroke. Both procedures demonstrated low risks for major stroke, myocardial infarction, or death.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurology
Background:
- Cerebrovascular disease poses a significant risk for stroke.
- Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are common interventions.
- Comparative effectiveness data for these procedures in real-world patient populations are crucial.
Purpose of the Study:
- To compare the safety and efficacy of carotid artery stenting versus carotid endarterectomy.
- To evaluate the composite endpoint of stroke, myocardial infarction, or death within 30 days.
- To assess long-term stroke rates following each intervention.
Main Methods:
- The Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST) was a large, randomized, prospective study.
- Enrolled patients with symptomatic or asymptomatic carotid artery stenosis.
- Compared outcomes between patients undergoing CAS and CEA.
Main Results:
- No significant difference was observed between CAS and CEA for the composite endpoint of stroke, myocardial infarction, or death at 30 days.
- Long-term stroke rates up to 4 years were similar between the two groups.
- Both interventions were associated with a low risk of major stroke.
Conclusions:
- Carotid artery stenting and carotid endarterectomy are equivalent treatment options for patients requiring revascularization.
- The choice between CAS and CEA should consider the specific procedural risks and patient factors.
- Further analysis is warranted regarding the impact of each procedure on stroke and myocardial infarction events.
Abstract:
The Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST) is the largest randomized prospective study to date to compare carotid artery stenting and carotid endarterectomy in a patient population similar to that seen in everyday practice. CREST showed stenting and surgery to be equivalent in terms of the composite end point of stroke, myocardial infarction (MI), or death within 30 days, as well as for the rate of stroke at up to 4 years (N Engl J Med 2010; 363:11-23). Importantly, the risk of major stroke was low with either intervention. However, the results need to be considered in the context of the impact of each procedure on stroke and MI.