In a pooled analysis of the CREST and ACT I trials, treatment of asymptomatic carotid stenosis with carotid artery stenting yielded similar outcomes to treatment with carotid endarterectomy, according to findings presented at the International Stroke Conference.
“Only two of the five recent, large randomized trials have compared carotid stenting and carotid endarterectomy in asymptomatic patients,” Jon S. Matsumura, MD, chairman of the division of vascular surgery at the University of Wisconsin School of Medicine and Public Health, said during a presentation. “Pooled analysis may better inform decision-making about these procedures.”
Leaders from both trials during the planning phase agreed to conduct a patient-level, prespecified pooled analysis of all asymptomatic non-octogenarian patients in the trials, Matsumura said.
The primary endpoint was a composite of periprocedural death/MI/stroke and ipsilateral stroke at 4 years.
The mean age of the 1,637 patients assigned stenting was 68 years and 62% were men. The mean age of the 907 patients assigned surgery was 68 years and 63% were men.
The primary endpoint occurred in 5.3% of the stenting group and 5.1% of the surgery group (HR = 1.02; 95% CI, 0.7-1.5), Matsumura said.
Among the periprocedural outcomes, MI was lower in the CAS group (0.6% vs. 1.7%; P = .01), whereas there was a trend toward stroke (2.7% vs. 1.5%; P = .07) and stroke or death (2.7% vs. 1.6%; P = .07) being lower in the surgery group, he said.
The 4-year rate of nonprocedural ipsilateral stroke was nearly identical in both groups (CAS, 2.3%; surgery, 2.2%; P = .97), according to the researchers.
The 4-year rates of stroke-free survival (CAS, 93.2%; surgery, 95.1%; P = .1) and overall survival (CAS, 91%; surgery, 90.2%; P = .923) were also similar, Matsumura said.
“This pooled analysis is the largest of randomized standard-risk asymptomatic patients,” he said. “Carotid stenting and carotid endarterectomy have similar rates of a composite of procedural complications and 4-year ipsilateral stroke.” – by Erik Swain
Hanlon B, et al. LB13. Presented at: International Stroke Conference; Feb. 5-8, 2019; Honolulu.
Disclosures: CREST was sponsored by the National Institute of Neurological Disorders and Stroke, and Abbott Vascular. ACT I was sponsored by Abbott Vascular. Matsumura reports he received grant support from Abbott, Cook Medical, Endologix, Medtronic and W.L. Gore and Associates.