TY - JOUR
T1 - Long-term results of stenting versus endarterectomy for carotid-artery stenosis
AU - the CREST Investigators
AU - Brott, Thomas G.
AU - Howard, George
AU - Roubin, Gary S.
AU - Meschia, James F.
AU - Mackey, Ariane
AU - Brooks, William
AU - Moore, Wesley S.
AU - Hill, Michael D.
AU - Mantese, Vito A.
AU - Clark, Wayne M.
AU - Timaran, Carlos H.
AU - Heck, Donald
AU - Leimgruber, Pierre P.
AU - Sheffet, Alice J.
AU - Howard, Virginia J.
AU - Chaturvedi, Seemant
AU - Lal, Brajesh K.
AU - Voeks, Jenifer H.
AU - Hobson, Robert W.
N1 - Funding Information:
Supported by a grant (U01 NS038384-11) from the National Institute of Neurological Disorders and Stroke of the National Institutes of Health and by Abbott Vascular Solutions (formerly Guidant), including donations of Accunet and Acculink systems to CREST centers in Canada and to CREST centers in the United States that were at Veterans Affairs sites. Support from Abbott Vascular Systems was equivalent to approximately 15% of the total study cost.Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.We thank the patients and their families for participation in this study; and the site principal investigators, who are listed in the Supplementary Appendix.
Publisher Copyright:
© Copyright 2016 Massachusetts Medical Society. All rights reserved.
PY - 2016/3/17
Y1 - 2016/3/17
N2 - 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.)
AB - 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.)
UR - http://www.scopus.com/inward/record.url?scp=84959455387&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84959455387&partnerID=8YFLogxK
U2 - 10.1056/NEJMoa1505215
DO - 10.1056/NEJMoa1505215
M3 - Article
C2 - 26890472
AN - SCOPUS:84959455387
SN - 0028-4793
VL - 374
SP - 1021
EP - 1031
JO - New England Journal of Medicine
JF - New England Journal of Medicine
IS - 11
ER -