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14-02-2011 | Stroke | Article

CREST supports CEA for symptomatic patients


Free abstract

MedWire News: Patients with symptomatic carotid artery stenosis are less likely to suffer periprocedural stroke if they are treated with carotid endarterectomy (CEA) rather than carotid artery stenting (CAS), shows an analysis of CREST.

"This difference may currently favor CEA," Thomas Brott (Mayo Clinic, Jacksonville, Florida, USA) and colleagues write in the journal Stroke.

"However, the disparity could potentially be reduced as new stent systems are introduced and as endovascular techniques improve."

CREST (Carotid Revascularization Endarterectomy vs Stenting Trial) included 1321 symptomatic and 1181 asymptomatic patients. The investigators felt it necessary to include asymptomatic patients because it is thought that at least 70% of patients who undergo CEA in the USA have no symptoms.

During 4 years of follow-up, the rate of stroke and death in the overall study population was significantly higher among patients who underwent CAS than in the CEA group, at 4.4% versus 2.3%. The corresponding rates among asymptomatic patients were not significantly different, at 2.5% and 1.4%.

But 6.0% of symptomatic patients suffered stroke or died following CAS, which was significantly more than the rate of 3.2% observed in the CEA group. Rates were slightly lower among patients younger than 80 years, at 5.6% after CAS and 2.6% after CEA.

Brott and colleagues stress that, regardless of the intervention used, periprocedural stroke rates remained within the 6% and 3% targets set for symptomatic and asymptomatic patients, respectively, in the American Heart Association/American Stroke Association guidelines.

"The CREST results imply that both CAS and CEA can be done with acceptable periprocedural risks by experienced surgeons and interventionalists," they conclude.

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Eleanor McDermid