Journal of Vascular Surgery
Volume 50, Issue 5 , Pages 1224-1231 , November 2009

The Carotid Revascularization Endarterectomy vs. Stenting Trial completes randomization: Lessons learned and anticipated results

  • Brajesh K. Lal, MD

      Affiliations

    • Division of Vascular Surgery, University of Maryland Medical Center, Baltimore, Md
    • ,
  • Thomas G. Brott, MD

      Affiliations

    • CREST Administrative Center, University of Medicine and Dentistry New Jersey-New Jersey Medical School, Newark, NJ
    • Department of Neurology, Mayo Clinic, Jacksonville, Fla
    • Corresponding Author InformationReprint requests: Thomas G. Brott, MD, Mayo Clinic, Griffin Building, 3rd Floor, 4500 San Pablo Rd., Jacksonville, FL 32224

Received 1 September 2009 ,Accepted 2 September 2009.

References 

  1. Gurm HS, Yadav JS, Fayad P, Katzen BT, Mishkel GJ, Bajwa TK, et al. Long-term results of carotid stenting versus endarterectomy in high-risk patients. N Engl J Med. 2008;358:1572–1579
  2. Yadav JS, Wholey MH, Kuntz RE, Fayad P, Katzen BT, Mishkel GJ, et al. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med. 2004;351:1493–1501
  3. Mas JL, Chatellier G, Beyssen B, Branchereau A, Moulin T, Becquemin JP, et al. Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med. 2006;355:1660–1671
  4. Eckstein HH, Ringleb P, Allenberg JR, Berger J, Fraedrich G, Hacke W, et al. Results of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: a multinational, prospective, randomised trial. Lancet Neurol. 2008;7:893–902
  5. Ringleb PA, Allenberg J, Bruckmann H, Eckstein HH, Fraedrich G, Hartmann M, et al. 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial. Lancet. 2006;368:1239–1247
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  9. Ederle J, Bonati LH, Dobson J, Featherstone RL, Gaines PA, Beard JD, et al. Endovascular treatment with angioplasty or stenting versus endarterectomy in patients with carotid artery stenosis in the Carotid And Vertebral Artery Transluminal Angioplasty Study (CAVATAS): long-term follow-up of a randomised trial. Lancet Neurol. 2009;8:898–907
  10. Bonati LH, Ederle J, McCabe DJ, Dobson J, Featherstone RL, Gaines PA, et al. Long-term risk of carotid restenosis in patients randomly assigned to endovascular treatment or endarterectomy in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): long-term follow-up of a randomised trial. Lancet Neurol. 2009;8:908–917
  11. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis (North American Symptomatic Carotid Endarterectomy Trial Collaborators). N Engl J Med. 1991;325:445–453
  12. Barnett HJ, Taylor DW, Eliasziw M, Fox AJ, Ferguson GG, Haynes RB, et al. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis (North American Symptomatic Carotid Endarterectomy Trial Collaborators). N Engl J Med. 1998;339:1415–1425
  13. Endarterectomy for asymptomatic carotid artery stenosis (Executive Committee for the Asymptomatic Carotid Atherosclerosis Study). JAMA. 1995;273:1421–1428
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  16. Hobson RW, Roubin G, Kathir K, Sheffet AJ, Leimgruber P, White C, et al. Closure of the Lead-in Phase of CREST (Carotid Revascularization Endarterectomy vs. Stenting Trial): 30-day and 1 year Analysis (International Stroke Conference). 2008;New Orleans, LA.
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  18. Hobson RW, Howard VJ, Roubin GS, Brott TG, Ferguson RD, Popma JJ, et al. Carotid artery stenting is associated with increased complications in octogenarians: 30-day stroke and death rates in the CREST lead-in phase. J Vasc Surg. 2004;40:1106–1111
  19. Hobson RW, Brooks W, Mackey A, Leimgruber P, Hye RJ, Cutlip D, et al. Periprocedural hemorrhagic and hemodynamic events are associated with increased risk in carotid artery stenting: The carotid revascularization endarterectomy versus stent trial (CREST). Stroke. 2007;38:483
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  21. Lal BK, Hobson RW, Tofighi B, Kapadia I, Cuadra S, Jamil Z. Duplex ultrasound velocity criteria for the stented carotid artery. J Vasc Surg. 2008;47:63–73
  22. Lutsep HL, Beach KW, Roubin G, Leimgruber P, Lal BK, Gray W, et al. Carotid lumen diameter changes one year after stenting: Results from the lead-in phase of CREST (International Stroke Conference). 2009;San Diego, CA.
  23. Howard VJ, Voeks JH, Lutsep HL, Mackey A, Milot G, Sam AD, et al. Does sex matter? Thirty-day stroke and death rates after carotid artery stenting in women versus men. Results from the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST) lead-in phase. Stroke. 2009;40:1140–1147

 Supported by National Institute of Neurological Disorders and Stroke-National Institutes of Health (NINDS-NIH) RO1 NS 038384. Additional funding was provided by Abbott Vascular.

 Competition of interest: none.

PII: S0741-5214(09)01833-3

doi: 10.1016/j.jvs.2009.09.003

Journal of Vascular Surgery
Volume 50, Issue 5 , Pages 1224-1231 , November 2009

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