Long-awaited results from the CREST (Carotid Revasculari-zation Endarterectomy versus Stenting Trial) study have been recently presented1 and gave a new light on carotid endarterectomy (CEA) and carotid stenting (CAS).CREST compared CAS to CEA for the treatment of carotid artery stenosis to prevent stroke in symptomatic and asymptomatic patients. More than 2500 patients were enrolled from more than 100 centers in North America and Canada over a 9-year period. The occurrence of the composite primary end-point of any stroke, myocardial infarction, or death during the periprocedural period or ipsilateral stroke on follow-up, was not significantly different in CEA and CAS groups: stenting 7.2%, surgery 6.8%. The overall safety and efficacy of the two procedures was largely the same with equal benefits for both men and women, and for patients with and without previous neurological symptoms. However, there were more heart attacks (2.3%) in the surgical group compared to 1.1% in the stenting group, and more strokes in the stenting group (4.1%) versus 2.3% for the surgical group in the weeks following the procedure. In particular, few strokes were disabling; the rate of non-disabling stroke was 2.7% for CAS vs. 1.4% for CEA, and the rate of disabling stroke was 1.4% for CAS vs. 0.8% for CEA, without achieving statistical significance.
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