Long-Term Results of Stenting versus Endarterectomy for Carotid-Artery Stenosis
Thomas G Brott, George Howard, Gary S Roubin, James F Meschia, Ariane Mackey, William Brooks, Wesley S Moore, Michael D Hill, Vito A Mantese, Wayne M Clark, Carlos H Timaran, Donald Heck, Pierre P Leimgruber, Alice J Sheffet, Virginia J Howard, Seemant Chaturvedi, Brajesh K Lal, Jenifer H Voeks, Robert W Hobson 2nd, CREST Investigators, Ariane Mackey, William Brooks, Michael D Hill, Vito Mantese, Wayne Clark, Carlos Timaran, Richard J Begg, Donald Heck, Pierre Leimgruber, Bart Demaerschalk, Richard Farb, David Chiu, Mohamed Mourisi, Michael Rinaldi, David C Lew, Lawrence Garcia, Mahmoud Malas, Lawrence Wechsler, Grant Stotts, Irfan Altafullah, Robert Bersin, Vijay Chilakamarri, Joseph Rapp, David Pelz, Robert Hye, Sriram Iyer, Zafar Jamil, William Stewart Horsley, Munier Nazzal, O W Brown, Albert Hakaim, Robert Bulas, Gary Ansel, Nicole Gonzales, Lee Burke, Robert Spetzler, James Castaldo, Victor Tran, Mansoor Qureshi, Louis Heller, L Nelson Hopkins, Kenneth Rosenfield, Fred Weaver, Alexander Shepard, David Burkart, James Elmore, Richard Powell, Anthony Pucillo, Walter Montanera, Barry Katzen, Craig Narins, Harry Cloft, Avery Evans, Daniel Selchen, Hollace Chastain, Robert Molnar, Ken Fraser, Sarah A Johnson, Mohamed Moursi, Lawrence Wechsler, Marc Schermerhorn, Philip Teal, William Gray, Jamal Zarghami, Randy Guzman, Vivek Rajagopal, Stephen P Murray, Mark Harrigan, Wesley S Moore, Richard McCann, Kim Hodgson, Mark Eskandari, Malcolm Foster, Robert Rosenwasser, Anthony Comerota, Karl Illig, Gregory Mishkel, Andrew Ringer, John D Martin, Jim Melton, John Hughes, Jose Biller, Charles Sternbergh 2nd, Frank Hellinger, Eric Lopez del Valle, Liberato A Iannone, Fayaz Shawl, Michael Golden, Daniel Benckart, Matthew Edwards, Kenneth Madden, Daniel Clair, Adam S Arthur, Steven Laster, Jay Howington, Manish Mehta, William Schickler, Richard Zelman, Ashraf Mansour, Michael Belkin, Harish Shownkeen, Alex Abou-Chebl, Thomas G Brott, George Howard, Gary S Roubin, James F Meschia, Ariane Mackey, William Brooks, Wesley S Moore, Michael D Hill, Vito A Mantese, Wayne M Clark, Carlos H Timaran, Donald Heck, Pierre P Leimgruber, Alice J Sheffet, Virginia J Howard, Seemant Chaturvedi, Brajesh K Lal, Jenifer H Voeks, Robert W Hobson 2nd, CREST Investigators, Ariane Mackey, William Brooks, Michael D Hill, Vito Mantese, Wayne Clark, Carlos Timaran, Richard J Begg, Donald Heck, Pierre Leimgruber, Bart Demaerschalk, Richard Farb, David Chiu, Mohamed Mourisi, Michael Rinaldi, David C Lew, Lawrence Garcia, Mahmoud Malas, Lawrence Wechsler, Grant Stotts, Irfan Altafullah, Robert Bersin, Vijay Chilakamarri, Joseph Rapp, David Pelz, Robert Hye, Sriram Iyer, Zafar Jamil, William Stewart Horsley, Munier Nazzal, O W Brown, Albert Hakaim, Robert Bulas, Gary Ansel, Nicole Gonzales, Lee Burke, Robert Spetzler, James Castaldo, Victor Tran, Mansoor Qureshi, Louis Heller, L Nelson Hopkins, Kenneth Rosenfield, Fred Weaver, Alexander Shepard, David Burkart, James Elmore, Richard Powell, Anthony Pucillo, Walter Montanera, Barry Katzen, Craig Narins, Harry Cloft, Avery Evans, Daniel Selchen, Hollace Chastain, Robert Molnar, Ken Fraser, Sarah A Johnson, Mohamed Moursi, Lawrence Wechsler, Marc Schermerhorn, Philip Teal, William Gray, Jamal Zarghami, Randy Guzman, Vivek Rajagopal, Stephen P Murray, Mark Harrigan, Wesley S Moore, Richard McCann, Kim Hodgson, Mark Eskandari, Malcolm Foster, Robert Rosenwasser, Anthony Comerota, Karl Illig, Gregory Mishkel, Andrew Ringer, John D Martin, Jim Melton, John Hughes, Jose Biller, Charles Sternbergh 2nd, Frank Hellinger, Eric Lopez del Valle, Liberato A Iannone, Fayaz Shawl, Michael Golden, Daniel Benckart, Matthew Edwards, Kenneth Madden, Daniel Clair, Adam S Arthur, Steven Laster, Jay Howington, Manish Mehta, William Schickler, Richard Zelman, Ashraf Mansour, Michael Belkin, Harish Shownkeen, Alex Abou-Chebl
Abstract
Background: In the Carotid Revascularization Endarterectomy versus Stenting Trial, we found no significant difference between the stenting group and the endarterectomy group with respect to the primary composite end point of stroke, myocardial infarction, or death during the periprocedural period or any subsequent ipsilateral stroke during 4 years of follow-up. We now extend the results to 10 years.
Methods: Among patients with carotid-artery stenosis who had been randomly assigned to stenting or endarterectomy, we evaluated outcomes every 6 months for up to 10 years at 117 centers. In addition to assessing the primary composite end point, we assessed the primary end point for the long-term extension study, which was ipsilateral stroke after the periprocedural period.
Results: Among 2502 patients, there was no significant difference in the rate of the primary composite end point between the stenting group (11.8%; 95% confidence interval [CI], 9.1 to 14.8) and the endarterectomy group (9.9%; 95% CI, 7.9 to 12.2) over 10 years of follow-up (hazard ratio, 1.10; 95% CI, 0.83 to 1.44). With respect to the primary long-term end point, postprocedural ipsilateral stroke over the 10-year follow-up occurred in 6.9% (95% CI, 4.4 to 9.7) of the patients in the stenting group and in 5.6% (95% CI, 3.7 to 7.6) of those in the endarterectomy group; the rates did not differ significantly between the groups (hazard ratio, 0.99; 95% CI, 0.64 to 1.52). No significant between-group differences with respect to either end point were detected when symptomatic patients and asymptomatic patients were analyzed separately.
Conclusions: Over 10 years of follow-up, we did not find a significant difference between patients who underwent stenting and those who underwent endarterectomy with respect to the risk of periprocedural stroke, myocardial infarction, or death and subsequent ipsilateral stroke. The rate of postprocedural ipsilateral stroke also did not differ between groups. (Funded by the National Institutes of Health and Abbott Vascular Solutions; CREST ClinicalTrials.gov number, NCT00004732.).
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Source: PubMed