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CREST: equipoise realized
  1. Felipe Albuquerque1,
  2. David Fiorella2,
  3. Joshua Hirsch3,
  4. Charles Prestigiacomo4,
  5. Osama Zaidat5,
  6. Robert Tarr6
  1. 1Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
  2. 2Department of Neurosurgery, Stony Brook University Medical Center, Stony Brook, New York, USA
  3. 3Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, Massachusetts, USA
  4. 4Department of Neurosurgery, University of Medicine and Dentistry of New Jersey, Newark New Jersey, USA
  5. 5Department of Neurology, Medical College of Wisconsin, Milwaukee Wisconsin, USA
  6. 6Department of Radiology, University Hospitals Case Medical Center, Cleveland, Ohio, USA
  1. Correspondence to Robert Tarr, Department of Radiology, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA; robert.tarr{at}uhhospitals.org

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The presentation of the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) results at February's International Stroke Conference established equivalent safety profiles for carotid endarterectomy (CEA) and carotid angioplasty and stenting (CAS).1 The much anticipated presentation, given by Dr Wayne Clark on behalf of the CREST investigators, has resulted in considerable excitement about future prospects for patients at risk for stroke. Given the well-established safety and efficacy of CEA, this finding is a tremendous accomplishment for practitioners of carotid stenting.

The study, a prospective, randomized, controlled trial with blinded endpoint adjudication, analyzed both symptomatic and asymptomatic patients. Outcomes will be reviewed for a total of 4 years after the initiation of the trial, which included 2502 patients treated at 117 sites throughout the United States and Canada. The equivalence in safety was largely determined by important differences in the rate of perioperative stroke and myocardial infarction (MI). While the notion that MI was weighted equal to stroke as a major adverse event (MAE) in a trial examining treatment arms designed to prevent only stroke might be questioned, …

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