CardioExchange Archive

Endarterectomy or Stenting? The results of the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST), which compared carotid endarterectomy to carotid stenting in 2,502 patients at centers in the U.S. and Canada, have now been published in the New England Journal of Medicine. The CREST investigators report that the 30-day rate of stroke, death, and MI combined with the rate of ipsilateral stroke over the next 4 years was similar in the two groups, occurring in 7.2% of patients in the stent group and 6.8% of patients in the surgery group (HR with stenting, 1.11; CI, 0.81-1.51; P=0.51). The 4-year rate of stroke or death was higher with stenting than with surgery (6.4% vs. 4.7%, P=0.03). In the periprocedural period, stroke occurred more often with stenting, while MI occurred more often with surgery.

In an accompanying editorial, Stephen Davis and Geoffrey Donnan conclude that although “individualization of treatment choices is appropriate,” surgery “remains the preferred treatment for most patients with symptomatic carotid stenosis.”

Note to readers: Following the initial presentation of CREST at a meeting earlier this year, Rick Lange launched a fascinating discussion on the Interventional Cardiology Blog by asking readers: “If it’s your carotid, endarterectomy or stenting?”

Growing FAME at 2 Years: New results from FAME (Fractional Flow Reserve [FFR] vs. Angiography for Multivessel Evaluation) demonstrate increasing benefits for FFR over time. Previously, early results of FAME had found that use of FFR reduced the rate of death, nonfatal MI, and repeat revascularization at 1 year. Now, Nico Pijls and the FAME Study Investigators report in the Journal of the American College of Cardiology that at 2 years, the rate of death or MI was 12.9% in the angiography-guided group versus 8.4% in the FFR-guided group (P=0.02). The finding, write the investigators, “supports the evolving paradigm of revascularization of ischemic lesions and medical treatment of nonischemic ones.”