title: Carotid Stenting Versus Carotid Endarterectomy: What Did the Carotid Revascularization Endarterectomy Versus Stenting Trial Show and Where Do We Go From Here?
abstract: Although rapidly expanding in its use, carotid artery stenting remains a relatively new procedure. Its growth is due, at least in part, to the perceived advantages of a less invasive technique. However, the clinical effectiveness and specific role for stenting in the treatment of carotid occlusive disease are still under evaluation. The primary aim of the randomized clinical trial, Carotid Revascularization Endarterectomy versus Stenting Trial (CREST), was to contrast the relative efficacy of carotid stenting versus carotid endarterectomy in preventing stroke, myocardial infarction, or death during a 30-day periprocedural period or ipsilateral stroke over the follow-up period in patients with symptomatic and asymptomatic extracranial carotid stenosis. The secondary goals were to describe the differential efficacy of the 2 procedures in men and women, contrast periprocedural (30-day) morbidity and postprocedural morbidity and mortality, estimate and contrast the restenosis rates of the 2 procedures, evaluate differences in measures of health-related quality of life and cost-effectiveness, and identify subgroups of participants at differential risk of stenting or surgery. This report summarizes the results obtained from CREST with respect to its primary and secondary aims.
authors: 1 Department of Vascular Surgery, University of Maryland, Baltimore, MD, USA.
authors: Brajesh K
authors: BK
authors: Lal
authors: 2 Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.
authors: James F
authors: JF
authors: Meschia
authors: 3 Department of Biostatistics, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA.
authors: George
authors: G
authors: Howard
authors: 2 Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.
authors: Thomas G
authors: TG
authors: Brott
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000401:mortality / Q000628:therapy*; D003362:Cost-Benefit Analysis; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D018570:Risk Assessment; D012737:Sex Factors; D015607:Stents; D020521:Stroke / Q000401:mortality / Q000517:prevention & control*; D016896:Treatment Outcome
keywords: carotid; endarterectomy; stenosis; stenting; stroke