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CREST. Primary outcome (death, MI, stroke at 30 days + ipsilateral stroke at 4 years) was similar between CAS and CEA arms (HR 1.11, 95% CI 0.81-1.51, p = 0.51) At 30 days, major strokes: 0.9% vs. 0.6%, p = 0.52; minor strokes: 3.2% vs. 1.7%, p = 0.01; MI: 1.1% vs. 2.3%, p = 0.03

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crest
CREST

Primary outcome (death, MI, stroke at 30 days + ipsilateral stroke at 4 years) was similar between CAS and CEA arms (HR 1.11, 95% CI 0.81-1.51, p = 0.51)

At 30 days, major strokes: 0.9% vs. 0.6%, p = 0.52; minor strokes: 3.2% vs. 1.7%, p = 0.01; MI: 1.1% vs. 2.3%, p = 0.03

Long-term stroke rate: 2.0% vs. 2.4%, p = 0.85

(p = 0.85)

(p = 0.51)

Trial design:Patients with significant carotid artery stenosis were randomized to either carotid artery stenting (CAS) or carotid endarterectomy (CEA). Clinical outcomes were compared at 4 years.

Results

10

10

7.2

6.8

5

5

Conclusions

%

%

  • CAS was associated with similar outcomes compared with CEA. Largest trial on this topic; different from earlier trials
  • Results true for both genders, and irrespective of symptoms
  • Left to be seen if CMS reconsiders coverage decision on CAS based on this study

2.4

2.0

0

0

Primary outcome

Long-term stroke

CAS

(n = 1,271)

CEA

(n = 1,251)

Brott TG, et al. N Engl J Med 2010;May 26:[Epub]