CREST Findings on Angiographic Characteristics Contributing to Periprocedural CAS Stroke and Death Risk Published

April 20, 2016—The higher stroke and death (S+D) risk for patients treated with carotid artery stenting (CAS) in CREST, the Carotid Revascularization Endarterectomy Versus Stenting Trial, appears to be largely isolated to those patients with longer lesion length and/or those with sequential and remote lesions, reported Wesley S. Moore, MD, et al on behalf of the CREST investigators in the Journal of Vascular Surgery (JVS, 2016;63:851–858). In the absence of those lesion characteristics, CAS appears to be as safe as carotid endarterectomy (CEA) with regard to periprocedural risk of S+D, concluded the CREST investigators.

As summarized in JVS, this evaluation sought to determine the factors that affected the CAS-CEA treatment differences and potentially to identify a subgroup of patients for whom CAS and CEA have equivalent periprocedural S+D risk. Patient and arterial characteristics were assessed as effect modifiers of the CAS-CEA treatment difference in 2,502 patients by the addition of factor-by-treatment interaction terms to a logistic regression model.

Lesion length and lesions that were contiguous or were sequential and noncontiguous extending remote from the bulb were identified as influencing the CAS-to-CEA S+D treatment difference. For patients with longer lesion length (≥ 12.85 mm), the risk of CAS was higher than that of CEA. Among patients with sequential or remote lesions extending beyond the bulb, the risk for S+D was higher for CAS relative to CEA. For the 37% of patients with lesions that were both short and contiguous, the odds of S+D in those treated with CAS was nonsignificantly 28% lower than for CEA, stated the investigators in JVS.

The findings were first presented at the 2015 Vascular Annual Meeting of the Society for Vascular Surgery, held June 17–20 in Chicago, Illinois.