The Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST)

Mantese, Vito A.; Timaran, Carlos H.; Chiu, David; Begg, Richard J.; Brott, Thomas G.

doi:10.1161/strokeaha.110.595330

Cited by 338 publications

(267 citation statements)

References 25 publications

Supporting

Mentioning

246

Contrasting

Unclassified

Order By: Relevance

“…We verified that 36.2% (US$ 645,570.10) of the total spent in each surgical procedure corresponds to the cost of the intensive care unit after CEA and 11% (US$ 30,645.78) after CAS. The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) 35 , conducted in the USA, showed that the initial cost with CAS is higher, costing an average of US$ 1,025 more per patient when compared with CEA, which corroborates Brazilian data.…”

Section: Economic Aspectssupporting

confidence: 72%

“…These results differ from the reality found in places such as USA, Canada and Europe. The risk of perioperative mortality in the CREST study ranged from a 0.3% for CEA and 0.7% for CAS [34][35][36] . In Brazil, not only are the mortality rates for both types of treatment higher, but also the inequalities in the risk of death between the two surgical modalities are not reproduced.…”

Section: Surgical Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Estenose de carótida extracraniana: revisão baseada em evidências

Flumignan

Navarro

2017

Rev. Col. Bras. Cir.

View full text Add to dashboard Cite

RESUMO A doença vascular cerebral extracraniana é uma das mais importantes causas de morte e de incapacidade em todo o mundo e seu tratamento se baseia em estratégias clínica e cirúrgica, sendo que esta última pode ser feita pelas técnicas convencional ou endovascular. O manejo da estenose da bifurcação carotídea visa principalmente a prevenir o acidente vascular cerebral e tem sido objeto de extensa investigação. O papel do tratamento clínico tem sido re-enfatizado, mas a endarterectomia de carótida permanece como o tratamento de primeira linha para pacientes sintomáticos com estenose de 50% a 99% e, para pacientes assintomáticos, com estenose de 60% a 99%. A angioplastia com stent é reservada para pacientes sintomáticos, com estenose de 50% a 99% e com risco elevado para a cirurgia aberta, por motivos anatômicos ou clínicos. Atualmente, o procedimento endovascular não é recomendado para pacientes assintomáticos que tenham condições de serem submetidos ao tratamento cirúrgico convencional. O Brasil apresenta tendência semelhante à de outros países da América do Norte e Europa, observando a manutenção da endarterectomia como a principal indicação para o tratamento da estenose carotídea e reservando o procedimento endovascular para casos em que há contraindicações para a primeira intervenção. Todavia, temos de melhorar os nossos resultados, reduzindo as complicações, notadamente a taxa de mortalidade geral.

show abstract

Section: Economic Aspectssupporting

confidence: 72%

Section: Surgical Resultsmentioning

confidence: 99%

Estenose de carótida extracraniana: revisão baseada em evidências

Flumignan

Navarro

2017

Rev. Col. Bras. Cir.

View full text Add to dashboard Cite

show abstract

“…However, most relevant clinical trials demonstrated that the rate of composite outcomes (disability stroke, myocardial infarction, or death) was not significantly different between patients treated with carotid artery stenting (CAS) and CEA during short-, intermediate-, and long-term follow-up (14)(15)(16)(17). These findings underscore that CAS in combination with the use of distal protective devices is non-inferior to CEA in the treatment of patients with symptomatic severe carotid artery stenosis.…”

Section: Introductionmentioning

confidence: 98%

The Safety of Protected Carotid Artery Stenting in Patients with Unstable Plaque on Carotid High-Resolution MR Imaging

Jeong

Kwak

Hwang

et al. 2018

J Korean Soc Radiol

View full text Add to dashboard Cite

Purpose:The aim of this study was to determine the safety of the carotid artery stenting (CAS) procedure, using an embolic protection device which is based on the presence of unstable plaques on carotid MR imaging in patients who presented with severe carotid artery stenosis. Materials and Methods: This prospective study assessed 102 consecutive patients who had been noted with severe carotid stenosis. These patients underwent a preprocedural carotid MR imaging, and a periprocedural diffusion-weighted imaging (DWI) after the CAS. The unstable plaque on the carotid MR imaging was defined as characterized as intraplaque hemorrhage (IPH), thin/ruptured fibrous caps, or ulcers. We analyzed the incidence of the noted periprocedural ipsilateral ischemic events on the DWI, and noted the primary outcomes within 30 days of the CAS. Results: In the study, it is noted that 50 patients (49.0%) had IPH, 84 patients (82.4%) had thin/ruptured fibrous caps, and 43 patients (42.2%) had ulcers as seen on the carotid plaque MR imaging. The IPH was more common in the symptomatic group than in the asymptomatic group (58.7% vs. 41.1%, p = 0.12). Overall, the DWI was positive after CAS in 25.5% of cases. Additionally, the combined rate of 30-day stroke, myocardial infarction, or death was recorded at 3.9%. The new periprocedural ischemic lesions on the DWI were characteristically more frequently observed in the symptomatic group (17/46, 37.0%) than in the asymptomatic group (9/56, 16.1%) (p = 0.03). There was no significant difference in the primary outcome of the CAS, based on the type of unstable plaque of IPH, thin/ruptured fibrous caps, or ulcers. Conclusion:The protected CAS appears to be safe, regardless of the noted unstable plaque findings as seen on the carotid MR imaging. In this case, because of the higher risk of periprocedural ipsilateral ischemic events, it is therefore recommended that the symptomatic patients should receive more careful treatment during the CAS placement going forward. Korea. Tel. 82-63-250-2582 Fax. 82-63-272-0481 E-mail: kwak8140@jbnu.ac.kr This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Index terms

show abstract

“…17,27) Although favorable outcomes have been obtained in high-risk patients treated with CAS, 30) procedure-related ischemic complications such as cerebral embolism 11,18) and acute stent thrombosis 10) have been reported. Dual antiplatelet therapy has been recommended to prevent these ischemic complications.…”

Section: Introductionmentioning

confidence: 99%

Cilostazol Reduces Periprocedural Hemodynamic Depression in Carotid Artery Stenting

Tsutsumi

Aikawa

Nii

et al. 2013

Neurol. Med. Chir.(Tokyo)

View full text Add to dashboard Cite

The clinical effects of two different types of antiplatelet drugs, cilostazol and thienopyridine drugs, were compared in patients treated by carotid artery stenting (CAS). Two hundred patients scheduled for CAS were randomized to either cilostazol or a thienopyridine drug (ticlopidine or clopidogrel). The study was conducted in open-label design. Aspirin was also given to all patients. All episodes of periprocedural hemodynamic instability (bradycardia, hypotension) were recorded together with all instances of stroke, cardiac morbidity, and death within 30 days of the procedure. Angiographic followup studies were conducted about 6 months after CAS. Finally, 197 patients were enrolled in this study; 97 were treated with cilostazol (cilostazol group) and 100 with a thienopyridine drug (thienopyridine group). In the 30-day follow-up period, the incidence of stroke, cardiac adverse effects, and death was not significantly different between the 2 groups (cilostazol group 7.2%, thienopyridine group 11.0%; p ＝ 0.85). The incidence of intra-and postprocedural bradycardia was significantly lower in the cilostazol group (cilostazol group 18.6% and 2.1%, thienopyridine group 40.0% and 18.0%, respectively; p º 0.01). Although the incidence of intraprocedural hypotension did not significantly differ between the 2 groups, postprocedural hypotension was significantly lower in the cilostazol group (16.5% vs. 34.0%, p º 0.01). In-stent restenosis on follow-up angiograms was lower in the cilostazol group but not significantly (0% vs. 4.4%, p ＝ 0.12). This small open-label study shows that cilostazol may reduce periprocedural bradycardia and hypotension compared with thienopyridine drugs in patients treated by CAS.

show abstract

The Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST)

Cited by 338 publications

References 25 publications

Estenose de carótida extracraniana: revisão baseada em evidências

Estenose de carótida extracraniana: revisão baseada em evidências

The Safety of Protected Carotid Artery Stenting in Patients with Unstable Plaque on Carotid High-Resolution MR Imaging

Cilostazol Reduces Periprocedural Hemodynamic Depression in Carotid Artery Stenting

Contact Info

Product

Resources

About