{"id":1545,"date":"2010-06-04T19:07:59","date_gmt":"2010-06-04T23:07:59","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/carotid-stenosis-stentremove-or-dont-touch\/"},"modified":"2011-07-19T17:44:17","modified_gmt":"2011-07-19T21:44:17","slug":"carotid-stenosis-stentremove-or-dont-touch","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2010\/06\/04\/carotid-stenosis-stentremove-or-dont-touch\/","title":{"rendered":"Carotid&nbsp; Stenosis: Stent,&nbsp;Remove or Don&#8217;t Touch?"},"content":{"rendered":"<p>The <a href=\"http:\/\/content.nejm.org\/cgi\/content\/full\/NEJMoa0912321\">Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST)<\/a> compared carotid stenting with endarterectomy in patients with symptomatic or asymptomatic carotid stenoses. The risk of the composite primary outcome \u2014 stroke, MI, or death \u2014 was similar for both treatments over the 2.5 years of follow-up.<br \/>\n<strong><em><\/em><\/strong><\/p>\n<p><strong><em>What\u2019s the nitty gritty?<\/em><\/strong><\/p>\n<p>Periprocedural stroke was more likely after stenting, and periprocedural MI was more likely after endarterectomy; but stroke had a greater impact on quality of life than MI.<\/p>\n<p>Given that neither CREST nor other recent trials have compared revascularization (by either stenting or endarterectomy) with optimal medical therapy in asymptomatic patients, the finding that rates of ipsilateral and contralateral stroke in these patients were similar (\u22481%\/yr) after the perioprocedural period could mean that (a) revascularization is durable (i.e., prevented cerebrovascular events) or (b) asymptomatic carotid stenosis is benign if treated medically.<\/p>\n<p><strong><em>Get off the fence&#8230;.<\/em><\/strong><\/p>\n<p>If <strong>YOU<\/strong> had asymptomatic 90% carotid stenosis, would you opt for medical therapy alone or request revascularization too?\u00a0 If so, how?<\/p>\n<p>Would you want additional risk stratification (i.e., transcranial Doppler) before making the decision?<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST) compared carotid stenting with endarterectomy in patients with symptomatic or asymptomatic carotid stenoses. The risk of the composite primary outcome \u2014 stroke, MI, or death \u2014 was similar for both treatments over the 2.5 years of follow-up. What\u2019s the nitty gritty? Periprocedural stroke was more likely after [&hellip;]<\/p>\n","protected":false},"author":214,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[20,1,9,16],"tags":[],"class_list":["post-1545","post","type-post","status-publish","format-standard","hentry","category-cardiac-surgery","category-general","category-interventional-cardiology","category-vascular"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/1545","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/214"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=1545"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/1545\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=1545"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=1545"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=1545"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}