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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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