TY - JOUR
T1 - Duration of asymptomatic status and outcomes following carotid endarterectomy and carotid artery stenting in the Carotid Revascularization Endarterectomy vs Stenting Trial
AU - CREST Investigators
AU - Moore, Wesley S.
AU - Voeks, Jenifer H.
AU - Roubin, Gary S.
AU - Clark, Wayne M.
AU - Howard, Virginia J.
AU - Jones, Michael R.
AU - Brott, Thomas G.
N1 - Funding Information:
Supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health ( U01 NS 038384 ). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Supplemental funding was provided by Abbott Vascular , Inc.
Funding Information:
Supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health (U01 NS 038384). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Supplemental funding was provided by Abbott Vascular, Inc. Supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health ( U01 NS 038384). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Supplemental funding was provided by Abbott Vascular, Inc. The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest.
Funding Information:
Supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health (U01 NS 038384). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Supplemental funding was provided by Abbott Vascular, Inc.
Publisher Copyright:
© 2018 Society for Vascular Surgery
PY - 2019/6
Y1 - 2019/6
N2 - Background: Most carotid revascularization studies define asymptomatic as symptom-free for more than 180 days; however, it is unknown if intervention carries similar risk among those currently asymptomatic but with previous symptoms (PS) vs those who were always asymptomatic (AA). Methods: We compared the periprocedural and 4-year risks of PS vs AA patients in the Carotid Revascularization Endarterectomy vs Stenting Trial (CREST) randomized to carotid endarterectomy (CEA) or carotid artery stenting (CAS)/angioplasty. Proportional hazards models adjusting for age, sex, and treatment were used to assess the risk of periprocedural stroke and/or death (S+D; any S+D during periprocedural period), stroke and death at 4 years (any S+D within the periprocedural period and ipsilateral stroke out to 4 years) and the primary end point at 4 years (any stroke, death, and myocardial infarction within the periprocedural period and ipsilateral stroke out to 4 years). Analysis was performed pooling the CEA-treated and CAS-treated patients, and separately for each treatment. Results: Of 1181 asymptomatic patients randomized in CREST, 1104 (93%) were AA and 77 (7%) were PS. There was no difference in risk when comparing the AA and PS cohorts in the pooled CAS+CEA population for periprocedural S+D (2.0% vs 1.3%), S+D at 4 years (3.6% vs 3.2%), or the primary end point (5.2% vs 5.8%). There were also no differences among those assigned to CEA (periprocedural S+D, 1.5% vs 0%; S+D at 4 years, 2.7% vs 0%; or primary end point, 5.1% vs 2.4%) or CAS (periprocedural S+D, 2.5% vs 2.8%; S+D at 4 years, 4.4% vs 6.9%; or primary end point, 5.3% vs 9.8%) when analyzed separately. Conclusions: In CREST, only a small minority of asymptomatic patients had previous ipsilateral symptoms. The outcomes of periprocedural S+D, periprocedural S+D, and ipsilateral stroke up to 4 years, and the primary end point did not differ for AA patients compared with PS patients.
AB - Background: Most carotid revascularization studies define asymptomatic as symptom-free for more than 180 days; however, it is unknown if intervention carries similar risk among those currently asymptomatic but with previous symptoms (PS) vs those who were always asymptomatic (AA). Methods: We compared the periprocedural and 4-year risks of PS vs AA patients in the Carotid Revascularization Endarterectomy vs Stenting Trial (CREST) randomized to carotid endarterectomy (CEA) or carotid artery stenting (CAS)/angioplasty. Proportional hazards models adjusting for age, sex, and treatment were used to assess the risk of periprocedural stroke and/or death (S+D; any S+D during periprocedural period), stroke and death at 4 years (any S+D within the periprocedural period and ipsilateral stroke out to 4 years) and the primary end point at 4 years (any stroke, death, and myocardial infarction within the periprocedural period and ipsilateral stroke out to 4 years). Analysis was performed pooling the CEA-treated and CAS-treated patients, and separately for each treatment. Results: Of 1181 asymptomatic patients randomized in CREST, 1104 (93%) were AA and 77 (7%) were PS. There was no difference in risk when comparing the AA and PS cohorts in the pooled CAS+CEA population for periprocedural S+D (2.0% vs 1.3%), S+D at 4 years (3.6% vs 3.2%), or the primary end point (5.2% vs 5.8%). There were also no differences among those assigned to CEA (periprocedural S+D, 1.5% vs 0%; S+D at 4 years, 2.7% vs 0%; or primary end point, 5.1% vs 2.4%) or CAS (periprocedural S+D, 2.5% vs 2.8%; S+D at 4 years, 4.4% vs 6.9%; or primary end point, 5.3% vs 9.8%) when analyzed separately. Conclusions: In CREST, only a small minority of asymptomatic patients had previous ipsilateral symptoms. The outcomes of periprocedural S+D, periprocedural S+D, and ipsilateral stroke up to 4 years, and the primary end point did not differ for AA patients compared with PS patients.
KW - Asymptomatic patients
KW - Carotid stenosis
KW - Prior symptoms in asymptomatic patients
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U2 - 10.1016/j.jvs.2018.09.054
DO - 10.1016/j.jvs.2018.09.054
M3 - Article
C2 - 30630649
AN - SCOPUS:85059538750
SN - 0741-5214
VL - 69
SP - 1797
EP - 1800
JO - Journal of Vascular Surgery
JF - Journal of Vascular Surgery
IS - 6
ER -