title: Health-related quality of life after carotid stenting versus carotid endarterectomy: results from CREST (Carotid Revascularization Endarterectomy Versus Stenting Trial).
abstract: OBJECTIVE
  The purpose of this study was to compare health-related quality of life (HRQOL) outcomes in patients treated with carotid artery stenting (CAS) versus carotid endarterectomy (CEA).
  
  
  BACKGROUND
  In CREST (Carotid Revascularization Endarterectomy versus Stenting Trial), the largest randomized trial of carotid revascularization to date, there was no significant difference in the primary composite endpoint, but rates of stroke and myocardial infarction (MI) differed between CAS and CEA. To help guide individualized clinical decision making, we compared HRQOL among patients enrolled in the CREST study. We also performed exploratory analyses to evaluate the association between periprocedural complications and HRQOL.
  
  
  METHODS
  We measured HRQOL at baseline, and after 2 weeks, 1 month, and 1 year among 2,502 patients randomly assigned to either CAS or CEA in the CREST study. The HRQOL was assessed using the Medical Outcomes Study Short-Form 36 (SF-36) and 6 disease-specific scales designed to study HRQOL in patients undergoing carotid revascularization.
  
  
  RESULTS
  At both 2 weeks and 1 month, CAS patients had better outcomes for multiple components of the SF-36, with large differences for role physical function, pain, and the physical component summary scale (all p < 0.01). On the disease-specific scales, CAS patients reported less difficulty with driving, eating/swallowing, neck pain, and headaches but more difficulty with walking and leg pain (all p < 0.05). However, by 1 year, there were no differences in any HRQOL measure between CAS and CEA. In the exploratory analyses, periprocedural stroke was associated with poorer 1-year HRQOL across all SF-36 domains, but periprocedural MI or cranial nerve palsy were not.
  
  
  CONCLUSIONS
  Among patients undergoing carotid revascularization, CAS is associated with better HRQOL during the early recovery period as compared with CEA-particularly with regard to physical limitations and pain-but these differences diminish over time and are not evident after 1 year. Although CAS and CEA are associated with similar overall HRQOL at 1 year, event-specific analyses confirm that stroke has a greater and more sustained impact on HRQOL than MI. (Carotid Revascularization Endarterectomy versus Stenting Trial [CREST]; NCT00004732)
authors.affiliation: Saint Luke's Mid America Heart and Vascular Institute, 4401 Wornall Road, Kansas City, MO 64111, USA. dcohen@saint-lukes.org
authors.forename: David J
authors.initials: DJ
authors.lastname: Cohen
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Stolker
authors.forename: Kaijun
authors.initials: K
authors.lastname: Wang
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Magnuson
authors.forename: Wayne M
authors.initials: WM
authors.lastname: Clark
authors.forename: Bart M
authors.initials: BM
authors.lastname: Demaerschalk
authors.forename: Albert D
authors.initials: AD
authors.lastname: Sam
authors.forename: James R
authors.initials: JR
authors.lastname: Elmore
authors.forename: Fred A
authors.initials: FA
authors.lastname: Weaver
authors.forename: Herbert D
authors.initials: HD
authors.lastname: Aronow
authors.forename: Larry B
authors.initials: LB
authors.lastname: Goldstein
authors.forename: Gary S
authors.initials: GS
authors.lastname: Roubin
authors.forename: George
authors.initials: G
authors.lastname: Howard
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Brott
mesh_terms: D017130:Angioplasty; D016893:Carotid Stenosis / Q000628:therapy*; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D015607:Stents; D016896:Treatment Outcome