Long-Term Results of Stenting versus Endarterectomy for Carotid-Artery Stenosis.

Authors

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
John Castaldo

Publication/Presentation Date

3-17-2016

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.).

Volume

374

Issue

11

First Page

1021

Last Page

1031

ISSN

1533-4406

Published In/Presented At

Brott, T. G., Howard, G., Roubin, G. S., Meschia, J. F., Mackey, A., Brooks, W., Moore, W. S., Hill, M. D., Mantese, V. A., Clark, W. M., Timaran, C. H., Heck, D., Leimgruber, P. P., Sheffet, A. J., Howard, V. J., Chaturvedi, S., Lal, B. K., Voeks, J. H., Hobson, R. W., 2nd, & CREST Investigators (2016). Long-Term Results of Stenting versus Endarterectomy for Carotid-Artery Stenosis. The New England journal of medicine, 374(11), 1021–1031. https://doi.org/10.1056/NEJMoa1505215

Disciplines

Medicine and Health Sciences

PubMedID

26890472

Department(s)

Department of Medicine

Document Type

Article