The CREST trial compared carotid endarterectomy (CEA) versus carotid artery stenting (CAS) for symptomatic and asymptomatic carotid stenosis. What was its key finding regarding periprocedural stroke risk?

• A CAS had lower periprocedural stroke risk than CEA in both symptomatic and asymptomatic patients
• B CEA and CAS had identical periprocedural complication profiles
• C CEA had lower periprocedural stroke risk but higher myocardial infarction risk than CAS ✓
• D CAS should replace CEA as first-line treatment for all symptomatic carotid stenosis

Explanation

The CREST trial demonstrated that CEA had a lower periprocedural stroke risk compared to CAS, while CAS had a lower periprocedural myocardial infarction risk. The composite endpoint (stroke, MI, death, or ipsilateral stroke) was similar between groups overall. However, periprocedural stroke had a greater impact on long-term functional outcome than MI, favouring CEA for patients in whom stroke risk is the primary concern. CEA remains preferred for older symptomatic patients; CAS may be preferred when surgical access is difficult or in younger patients with specific anatomy.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.