Informing vs Changing the Practice of Carotid Revascularization

The Carotid Revascularization Endarterectomy vs Stenting Trial (CREST) was a multicenter randomized clinical trial directly comparing the risks and benefits of stenting with those of endarterectomy for symptomatic and asymptomatic high-grade stenosis. Involving 2502 patients across the United States and Canada followed-up for up to 10 years, the trial did not detect significant differences in the end point of perioperative stroke, myocardial infarction, or death or ipsilateral ischemic stroke after the perioperative period. Primary results were published in 2010. CREST clearly informed practice guidelines, but the extent to which CREST altered practice is less clear. The effects of CREST on the practice of stenting may have been muted because not everyone accepts the validity of having included perioperative myocardial infarction in the primary composite end point, although the trial showed that perioperative myocardial infarction carried significant morbidity. Perioperative myocardial infarction increased mortality by more than 3-fold. In CREST, there were subtle absolute differences in event rates and opposing trends in perioperative stroke and perioperative myocardial infarction rates.
Source: JAMA Neurology - Category: Neurology Source Type: research