The Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST): Stenting Versus Carotid Endarterectomy for Carotid Disease

Overview

Journal Stroke

Specialties Cardiology & Vascular Diseases
Neurology

Date 2010 Sep 30

PMID 20876500

Citations 88

Authors

Vito A Mantese

Carlos H Timaran

David Chiu

Richard J Begg

Thomas G Brott

Affiliations

Soon will be listed here.

Abstract

Background And Purpose: Carotid artery stenosis causes up to 10% of all ischemic strokes. Carotid endarterectomy (CEA) was introduced as a treatment to prevent stroke in the early 1950s. Carotid stenting (CAS) was introduced as a treatment to prevent stroke in 1994.

Methods: The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) is a randomized trial with blinded end point adjudication. Symptomatic and asymptomatic patients were randomized to CAS or CEA. The primary end point was the composite of any stroke, myocardial infarction, or death during the periprocedural period and ipsilateral stroke thereafter, up to 4 years.

Results: There was no significant difference in the rates of the primary end point between CAS and CEA (7.2% versus 6.8%; hazard ratio, 1.11; 95% CI, 0.81 to 1.51; P=0.51). Symptomatic status and sex did not modify the treatment effect, but an interaction with age and treatment was detected (P=0.02). Outcomes were slightly better after CAS for patients aged <70 years and better after CEA for patients aged >70 years. The periprocedural end point did not differ for CAS and CEA, but there were differences in the components, CAS versus CEA (stroke 4.1% versus 2.3%, P=0.012; and myocardial infarction 1.1% versus 2.3%, P=0.032).

Conclusions: In CREST, CAS and CEA had similar short- and longer-term outcomes. During the periprocedural period, there was higher risk of stroke with CAS and higher risk of myocardial infarction with CEA. Clinical Trial Registration-www.clinicaltrials.gov. Unique identifier: NCT00004732.

Citing Articles

Association of Plaque Characteristics With New Ischemic Lesions After Carotid Artery Stenting.

Zhang S, Feng M, Yu F, Meng X, Zhang Y, Cui B CNS Neurosci Ther. 2025; 31(3):e70312.

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Management of plaque protrusion in transcarotid artery revascularization with stent-in-stent technique.

Wong A, Nigh N, Cunningham K, Saatzer M, Beeman B J Vasc Surg Cases Innov Tech. 2025; 11(2):101733.

PMID: 40026651 PMC: 11872068. DOI: 10.1016/j.jvscit.2025.101733.

CAS-OPCABG vs OPCABG-alone in patients with asymptomatic carotid Stenosis: Multi-center experience.

Wen M, Li J, Jia S, Wang S, Zhao S, Su P Int J Cardiol Heart Vasc. 2025; 56():101497.

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Forearm access for carotid artery stenting using the dual protection of flow reversal and distal filter: Trans-forearm dual protection technique.

Hanaoka Y, Koyama J, Kubota Y, Nakamura T, Kitamura S, Yamazaki D Interv Neuroradiol. 2024; :15910199241270903.

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Brazilian Angiology and Vascular Surgery Society Guidelines for the treatment of extracranial cerebrovascular disease.

Ristow A, Massiere B, Meirelles G, Casella I, Morales M, Moreira R J Vasc Bras. 2024; 23:e20230094.

PMID: 39099701 PMC: 11296686. DOI: 10.1590/1677-5449.202300942.

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