CREST
Carotid Revascularization Endarterectomy versus Stenting Trial
Doente / População Intervenção / Exposição Comparação Desfecho
In 2,502 patients with symptomatic or asymptomatic carotid stenosis, carotid-artery stenting did not differ from carotid endarterectomy for periprocedural stroke, myocardial infarction or death, or subsequent ipsilateral stroke at 4 years.
N
2502
Desenho
Open-label RCT with blinded endpoint adjudication
Desfecho
Composite of periprocedural stroke, MI or death, plus ipsilateral stroke within 4 years
Relevância
2
Resultado7.2 % vs 6.8 % (HR 1.11; 95 % CI 0.81–1.51; p=0.51). The trade-off was directional: periprocedural stroke 4.1 % vs 2.3 % (p=0.01) but periprocedural MI 1.1 % vs 2.3 % (p=0.03).
Brott TG, Hobson RW 2nd, et al. N Engl J Med. 2010;363(1):11-23. 10.1056/NEJMoa0912321
Discussão e crítica
The composite weights a periprocedural infarct equally with a stroke, which flatters stenting, and the operators were highly credentialled. It established procedural equipoise and made the stroke-versus-infarct trade-off, rather than the overall event rate, the basis for choosing between stenting and surgery.