CREST Analysis Demonstrates Equally Low Restenosis Rates for CAS and CEA

February 1, 2012—At the American Stroke Association's (ASA) International Stroke Conference in New Orleans, Louisiana, Brajesh K. Lal, MD, presented 2-year findings on restenosis rates from an analysis of the CREST (Carotid Revascularization Endarterectomy Versus Stenting Trial) study.

The data demonstrated similar restenosis outcomes for carotid endarterectomy (CEA) and carotid artery stenting (CAS). The trial, which is the largest to examine restenosis rates after either procedure, found that < 7% of patients had developed restenosis at 2 years after either procedure. Monitoring of CREST participants will continue through 10 years, advised the ASA.

“Unlike bare-metal stents placed in coronary arteries, where reblockage occurs about 20% of the time, we found the reblockage rates in the carotid artery were quite small,” stated Dr. Lal. “Patients and physicians can be reassured that both procedures are durable and that reblockage rates are equivalent, so they can use different criteria to determine which procedure is right for a patient.”

According to the ASA, the current study was composed of 1,086 patients who received CAS and 1,105 who underwent CEA. All patients were assessed at 1, 6, 12, and 24 months after the procedure with ultrasound to identify those who had developed a 70% or greater blockage in the treated section. Previous data in this head-to-head comparison of the two procedures showed no difference in the combined rates of stroke, heart attack, or death between patients undergoing CEA or CAS.

Dr. Lal reported that after 2 years, the investigators found identical rates of restenosis (5.8%) after CAS and CEA, complete occlusion rates of 0.3% after CAS versus 0.5% after CEA, and combined restenosis/occlusion rates of 6% after CAS versus 6.3% after CEA. Subsequent procedures to open reblocked carotid arteries were performed in 20 CAS patients and 23 CEA patients. Rates of restenosis were approximately double in women and patients with diabetes and abnormal lipid levels; stroke rates were four times higher in patients who developed restenosis compared to those that did not develop restenosis during follow-up. Dr. Lal commented, “These may be groups we need to focus more on by monitoring them closely and aggressively controlling risk factors after the procedures.” 

“CREST was unique in having a built-in training and credentialing process that mandated participating physicians perform 1,500 revascularization procedures before randomizing any patients,” noted Dr. Lal, who also observed that the results did not differ by the specialty of the physician performing the procedure. “These results provide hard data for the FDA and professional societies to use as they recommend a particular type or extent of training for performing these procedures.”