Review of the CREST trial of carotid stenting

The CREST trial, published earlier this year, was the latest large-scale, randomized, controlled trial to test the safety and efficacy of carotid artery stenting versus standard open CEA surgery. Divisions of the HHS and medical societies might next make changes to reimbursement and clinical guidelines based on the trial. The PI and lead author, Thomas Brott of the Mayo Clinic in Florida, discussed the paper. Topics discussed include:

  • The results which met the primary endpoint: a composite of death, stroke, or MI
  • Were the periprocedural minor strokes caused by the stents releasing debris
  • Were the greater number of myocardial infractions seen in the CEA surgery group significant Q-wave MI’s or just enzyme bumps?
  • The other carotid stenting trial from the ICSS group that showed in a subset of patients MRI evidence of stroke more often with the stent group than CEA


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