CAROTID ENDARTERECTOMY BEATS STENTING/ANGIOPLASTY IN CREST

From Physician’s First Watch for May 27, 2010 David G. Fairchild, MD, MPH, Editor-in-Chief

“CREST Trial Points to Endarterectomy as Preferred Stroke Preventive Strategy

A comparison of endarterectomy versus stenting in treating carotid artery stenosis shows that stent recipients are at higher risk for stroke within 30 days of the procedure, according to a New England Journal of Medicine study released online.

Investigators in the CREST trial randomized some 2500 patients with carotid artery stenosis to either stenting or endarterectomy. After a median follow-up of 2.5 years, the groups showed no significant difference in the primary endpoint — a composite of stroke, myocardial infarction, or death from any cause during the periprocedural period, or ipsilateral stroke within 4 years.

However, the 4-year rate of stroke or death significantly favored endarterectomy. When the individual outcomes were examined, there were significantly more periprocedural strokes after stenting, and more MIs after endarterectomy.

Editorialists conclude that “endarterectomy remains the preferred treatment for most patients.”

NEJM article (Free)

NEJM editorial (Free)

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