Differences in long-term outcomes between stenting and endarterectomy for significant carotid artery stenosis remain unclear. Recently, the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) published extended 10 year results. Among 2502 randomized patients with both symptomatic and asymptomatic significant carotid stenosis, there was no difference in the rate of the primary composite end point (stroke, myocardial infarction, or death) between the stenting group (11.8%) and the endarterectomy group (9.9%). Additionally, there was no significant difference in post-procedural ipsilateral stroke over the 10-year follow-up in the stenting group (6.9%) or endarterectomy (5.6%). No significant between-group differences with respect to either end point were detected when symptomatic patients and asymptomatic patients were analyzed separately. This study adds important long-term evidence that stenting may achieve similar outcomes as endarterectomy for patients with significant carotid artery stenosis.
New England Journal of Medicine