1. Follow-up of CREST trial: no difference in restenosis rates between stenting and surgery

摘要

It should sound like music to interventionalists. The new results from carotid revascularisation endarterectomy versus stenting trial (CREST) show that after 2 years of follow-up, restenosis rates are equal whether the patient underwent stenting or surgery. The data was presented at New Orleans recently during the International Stroke conference by Dr. Brajesh K. Lai. The rates of restenosis/occlusion were 6% and 6.3% in the stenting and surgery groups respectively (difference not statistically significant). The CREST trial is one of the recent and well-discussed trials in the area of carotid stenting and surgery that enrolled 2500 patients from 117 US and Canadian centres. The composite end-point was a combination of any stroke, myocardial infarction (MI), or death during the peri-procedural period and ipsilateral stroke during follow-up. Stenting was associated with a 7.2% event rate versus 6.8% with surgery, again non-significant difference. However, the stroke was higher with stenting while MI was higher with endarterectomy. The present analysis showed that during the follow-up by Doppler ultrasound, similar rates of restenosis (>70% diameter reduction)/occlusion were demonstrated between the stenting and surgery arms. The risk factors for restenosis in this analysis showed that women and patients with diabetes mellitus or dyslipidemia had double the risk.