Stenting versus endarterectomy for treatment of carotid-artery stenosis
Thomas G Brott, Robert W Hobson 2nd, George Howard, Gary S Roubin, Wayne M Clark, William Brooks, Ariane Mackey, Michael D Hill, Pierre P Leimgruber, Alice J Sheffet, Virginia J Howard, Wesley S Moore, Jenifer H Voeks, L Nelson Hopkins, Donald E Cutlip, David J Cohen, Jeffrey J Popma, Robert D Ferguson, Stanley N Cohen, Joseph L Blackshear, Frank L Silver, J P Mohr, Brajesh K Lal, James F Meschia, CREST Investigators, W Clark, W Brooks, A Mackey, M Hill, A Buchan, P Leimgruber, V Mantese, C Timaran, L N Hopkins, D Chiu, R Begg, Z Jamil, R Hye, B Demaerschalk, O W Brown, G S Roubin, S Iyer, D Heck, R Farb, W Montanera, S K Lee, I Altafullah, G Ansel, A Sam 2nd, N Gonzales, M Campbell, J Choi, P Soukas, L Wechsler, D Clair, K Ouriel, M Reisman, W Gray, J Eidt, S Orlow, J Burke, S Sorenson, P J Casterella, M Malas, K Murphy, M Rinaldi, K Rosenfield, C Sternbergh 3rd, R Felberg, R McCann, T Smith, C O'Mara, A Hakaim, B Katzen, R Spetzler, A Pucillo, J Elmore, W Jordan, D Lew, R Powell, R Bulas, B Kluck, J Rapp, G Mishkel, F Weaver, M Nazzal, C Narins, R Molnar, M Eskandari, H Aronow, F Shawl, R Rosenwasser, H Chastain, M Foster, R Raabe, D Pelz, G Stotts, H Cloft, L Heller, W Knopf, B Reddy, K Hodgson, K Fraser, W Gray, J P Mohr, A Shepard, D Reddy, W Montanera, W Moore, E Chaikof, B Stern, S Johnson, R Zelman, A Evans, D Burkart, D Bandyk, P Karanjia, J Zarghami, A Arthur, J Barr, M Mehta, A Comerota, K Natarajan, K Krol, J Howington, D Selchen, M Schermerhorn, F W LoGerfo, S Laster, M Sanz, E Lopez del Valle, J Andriole, A Ringer, J Martin, R Guzman, P Teal, F Hellinger, G Petrossian, R B Berroya, M Bates, J Mills, M Golden, R Fairman, A Mansour, A MacBeth, H Madyoon, L A Iannone, K Hansen, J Biller, J Shuck, P Gobin, K Dauterman, J Melton, D Benckart, W Lesley, M Belkin, T Bajwa, S Myla, J Snell, H Shownkeen, A Abou-Chebl, T G Brott, R W Hobson 2nd, K W Beach, D J Cohen, J Cordell, D E Cutlip, R D Ferguson, L N Hopkins, G Howard, V J Howard, L Keene, B K Lal, J F Meschia, J P Mohr, W S Moore, J Popma, G S Roubin, A J Sheffet, F L Silver, S N Cohen, J Biller, J P Broderick, S Chaturvedi, M A Kalafut, E J Skalabrin, J L Blackshear, S P Glasser, R J Prineas, J Marsh, R Higashida, G Lamas, B Tilley, M Walker, G R Cutter, Thomas G Brott, Robert W Hobson 2nd, George Howard, Gary S Roubin, Wayne M Clark, William Brooks, Ariane Mackey, Michael D Hill, Pierre P Leimgruber, Alice J Sheffet, Virginia J Howard, Wesley S Moore, Jenifer H Voeks, L Nelson Hopkins, Donald E Cutlip, David J Cohen, Jeffrey J Popma, Robert D Ferguson, Stanley N Cohen, Joseph L Blackshear, Frank L Silver, J P Mohr, Brajesh K Lal, James F Meschia, CREST Investigators, W Clark, W Brooks, A Mackey, M Hill, A Buchan, P Leimgruber, V Mantese, C Timaran, L N Hopkins, D Chiu, R Begg, Z Jamil, R Hye, B Demaerschalk, O W Brown, G S Roubin, S Iyer, D Heck, R Farb, W Montanera, S K Lee, I Altafullah, G Ansel, A Sam 2nd, N Gonzales, M Campbell, J Choi, P Soukas, L Wechsler, D Clair, K Ouriel, M Reisman, W Gray, J Eidt, S Orlow, J Burke, S Sorenson, P J Casterella, M Malas, K Murphy, M Rinaldi, K Rosenfield, C Sternbergh 3rd, R Felberg, R McCann, T Smith, C O'Mara, A Hakaim, B Katzen, R Spetzler, A Pucillo, J Elmore, W Jordan, D Lew, R Powell, R Bulas, B Kluck, J Rapp, G Mishkel, F Weaver, M Nazzal, C Narins, R Molnar, M Eskandari, H Aronow, F Shawl, R Rosenwasser, H Chastain, M Foster, R Raabe, D Pelz, G Stotts, H Cloft, L Heller, W Knopf, B Reddy, K Hodgson, K Fraser, W Gray, J P Mohr, A Shepard, D Reddy, W Montanera, W Moore, E Chaikof, B Stern, S Johnson, R Zelman, A Evans, D Burkart, D Bandyk, P Karanjia, J Zarghami, A Arthur, J Barr, M Mehta, A Comerota, K Natarajan, K Krol, J Howington, D Selchen, M Schermerhorn, F W LoGerfo, S Laster, M Sanz, E Lopez del Valle, J Andriole, A Ringer, J Martin, R Guzman, P Teal, F Hellinger, G Petrossian, R B Berroya, M Bates, J Mills, M Golden, R Fairman, A Mansour, A MacBeth, H Madyoon, L A Iannone, K Hansen, J Biller, J Shuck, P Gobin, K Dauterman, J Melton, D Benckart, W Lesley, M Belkin, T Bajwa, S Myla, J Snell, H Shownkeen, A Abou-Chebl, T G Brott, R W Hobson 2nd, K W Beach, D J Cohen, J Cordell, D E Cutlip, R D Ferguson, L N Hopkins, G Howard, V J Howard, L Keene, B K Lal, J F Meschia, J P Mohr, W S Moore, J Popma, G S Roubin, A J Sheffet, F L Silver, S N Cohen, J Biller, J P Broderick, S Chaturvedi, M A Kalafut, E J Skalabrin, J L Blackshear, S P Glasser, R J Prineas, J Marsh, R Higashida, G Lamas, B Tilley, M Walker, G R Cutter
Abstract
Background: Carotid-artery stenting and carotid endarterectomy are both options for treating carotid-artery stenosis, an important cause of stroke.
Methods: We randomly assigned patients with symptomatic or asymptomatic carotid stenosis to undergo carotid-artery stenting or carotid endarterectomy. The primary composite end point was stroke, myocardial infarction, or death from any cause during the periprocedural period or any ipsilateral stroke within 4 years after randomization.
Results: For 2502 patients over a median follow-up period of 2.5 years, there was no significant difference in the estimated 4-year rates of the primary end point between the stenting group and the endarterectomy group (7.2% and 6.8%, respectively; hazard ratio with stenting, 1.11; 95% confidence interval, 0.81 to 1.51; P=0.51). There was no differential treatment effect with regard to the primary end point according to symptomatic status (P=0.84) or sex (P=0.34). The 4-year rate of stroke or death was 6.4% with stenting and 4.7% with endarterectomy (hazard ratio, 1.50; P=0.03); the rates among symptomatic patients were 8.0% and 6.4% (hazard ratio, 1.37; P=0.14), and the rates among asymptomatic patients were 4.5% and 2.7% (hazard ratio, 1.86; P=0.07), respectively. Periprocedural rates of individual components of the end points differed between the stenting group and the endarterectomy group: for death (0.7% vs. 0.3%, P=0.18), for stroke (4.1% vs. 2.3%, P=0.01), and for myocardial infarction (1.1% vs. 2.3%, P=0.03). After this period, the incidences of ipsilateral stroke with stenting and with endarterectomy were similarly low (2.0% and 2.4%, respectively; P=0.85).
Conclusions: Among patients with symptomatic or asymptomatic carotid stenosis, the risk of the composite primary outcome of stroke, myocardial infarction, or death did not differ significantly in the group undergoing carotid-artery stenting and the group undergoing carotid endarterectomy. During the periprocedural period, there was a higher risk of stroke with stenting and a higher risk of myocardial infarction with endarterectomy. (ClinicalTrials.gov number, NCT00004732.)
2010 Massachusetts Medical Society
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Source: PubMed