Carotid Artery Stenting Lessons From CREST (Carotid Revascularization Endarterectomy Versus Stenting Trial)

The take-home message from the CREST is that for low to average surgical risk patients with symptomatic or asymptomatic carotid artery stenosis, CAS and CEA in qualified hands, have comparable outcomes. It also highlights the importance of factors such as operator experience and training, the use of embolic protection, and an awareness of the potential reporting and ascertainment bias that may occur in nonrandomized trials. The CREST results confirm that in experienced centers and with experienced operators, patients and their physicians should be able to individually tailor therapy for stroke prevention by choosing either CAS or CEA, a view reinforced by the editorialists of the study who concluded ". . . given the lack of significant difference in the rate of long-term outcomes, the individualization of treatment choices is appropriate" (29). © 2010 American College of Cardiology Foundation.