@article{2406d503ae5745fd93addc645acef2b8,
title = "Treatment of carotid stenosis in asymptomatic, nonoctogenarian, standard risk patients with stenting versus endarterectomy trials",
abstract = "Objective: Asymptomatic carotid stenosis is the most frequent indication for carotid endarterectomy (CEA) in the United States. Published trials and guidelines support CEA indications in selected patients with longer projected survival and when periprocedural complications are low. Transfemoral carotid artery stenting with embolic protection (CAS) is a newer treatment option. The objective of this study was to compare outcomes in asymptomatic, nonoctogenarian patients treated with CAS vs CEA. Methods: Patient-level data was analyzed from 2544 subjects with ≥70% asymptomatic carotid stenosis who were randomized to CAS or CEA in addition to standard medical therapy. One trial enrolled 1091 (548 CAS, 543 CEA) and another enrolled 1453 (1089 CAS, 364 CEA) asymptomatic patients less than 80 years old (upper age eligibility). Independent neurologic assessment and routine cardiac enzyme screening were performed. The prespecified, primary composite endpoint was any stroke, myocardial infarction, or death during the periprocedural period or ipsilateral stroke within 4 years after randomization. Results: There was no significant difference in the primary endpoint between CAS and CEA (5.3% vs 5.1%; hazard ratio, 1.02; 95% confidence interval, 0.7-1.5; P = .91). Periprocedural rates for the components are (CAS vs CEA): any stroke (2.7% vs 1.5%; P = .07), myocardial infarction (0.6% vs 1.7%; P = .01), death (0.1% vs 0.2%; P = .62), and any stroke or death (2.7% vs 1.6%; P = .07). After this period, the rates of ipsilateral stroke were similar (2.3% vs 2.2%; P = .97). Conclusions: In a pooled analysis of two large randomized trials of CAS and CEA in asymptomatic, nonoctogenarian patients, CAS achieves comparable short- and long-term results to CEA.",
keywords = "Carotid, Carotid stenosis, Endarterectomy, Random allocation, Stents",
author = "Matsumura, {Jon S.} and Hanlon, {Bret M.} and Kenneth Rosenfield and Voeks, {Jenifer H.} and George Howard and Roubin, {Gary S.} and Brott, {Thomas G.}",
note = "Funding Information: The Asymptomatic Carotid Trial I (ACT I) was funded by Abbott Vascular . The Carotid Revascularization Endarterectomy versus Stent Trial (CREST) was supported by the National Institute of Neurological Disorders and Stroke and the National Institutes of Health ( R01 NS 038384 ) and supplemental funding from Abbott Vascular Solutions (formerly Guidant), including donations of Accunet and Acculink systems, equivalent to approximately 15% of the total study cost, to CREST centers in Canada and to CREST centers in the United States that were at Veterans Affairs sites. Funding for this pooled analysis was provided by the University of Wisconsin School of Medicine , Division of Vascular Surgery Joyce Jarding Research Fund, Madison, Wisc, and Massachusetts General Hospital, Boston, Mass. Funding Information: Author conflict of interest: J.S.M. reports research grants from Abbott , Cook , Medtronic , Endologix , Gore , and the National Institutes of Health (NIH). B.M.H. reports research grants from the Patient-Centered Outcomes Research Institute and NIH. T.B. reports a research grant from the NIH ; royalties from GR Cook Inc; and equity in Contego Medical Inc and InspireMD. K.R. reports consultant/scientific advisory board for Abbott Vascular, Access Closure, BTG, Cordis-Cardinal Health, EXIMO, Volcano-Philips, Surmodics, Shockwave, Cruzar, Capture Vascular, Endospan, Janssen, Magneto, MD Insider, Micell, Silk Road, Valcare, Thrombolex, and the University of Maryland; grants/contracts from NIH and Inari ; equity in Access Closure, AngioDynamics, Contego, Endospan, Embolitech, EXIMO, JanaCare, PQ Bypass, Primacea, MD Insider, Silk Road, Cruzar Systems, Capture Vascular, Micell, and Valcare; and board member for VIVA Physicians and National PERT Consortium. Funding Information: The Asymptomatic Carotid Trial I (ACT I) was funded by Abbott Vascular. The Carotid Revascularization Endarterectomy versus Stent Trial (CREST) was supported by the National Institute of Neurological Disorders and Stroke and the National Institutes of Health (R01 NS 038384) and supplemental funding from Abbott Vascular Solutions (formerly Guidant), including donations of Accunet and Acculink systems, equivalent to approximately 15% of the total study cost, to CREST centers in Canada and to CREST centers in the United States that were at Veterans Affairs sites. Funding for this pooled analysis was provided by the University of Wisconsin School of Medicine, Division of Vascular Surgery Joyce Jarding Research Fund, Madison, Wisc, and Massachusetts General Hospital, Boston, Mass.Author conflict of interest: J.S.M. reports research grants from Abbott, Cook, Medtronic, Endologix, Gore, and the National Institutes of Health (NIH). B.M.H. reports research grants from the Patient-Centered Outcomes Research Institute and NIH. T.B. reports a research grant from the NIH; royalties from GR Cook Inc; and equity in Contego Medical Inc and InspireMD. K.R. reports consultant/scientific advisory board for Abbott Vascular, Access Closure, BTG, Cordis-Cardinal Health, EXIMO, Volcano-Philips, Surmodics, Shockwave, Cruzar, Capture Vascular, Endospan, Janssen, Magneto, MD Insider, Micell, Silk Road, Valcare, Thrombolex, and the University of Maryland; grants/contracts from NIH and Inari; equity in Access Closure, AngioDynamics, Contego, Endospan, Embolitech, EXIMO, JanaCare, PQ Bypass, Primacea, MD Insider, Silk Road, Cruzar Systems, Capture Vascular, Micell, and Valcare; and board member for VIVA Physicians and National PERT Consortium. 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. Publisher Copyright: {\textcopyright} 2021 Society for Vascular Surgery",
year = "2022",
month = apr,
doi = "10.1016/j.jvs.2021.10.020",
language = "English (US)",
volume = "75",
pages = "1276--1283.e1",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
publisher = "Mosby Inc.",
number = "4",
}