Carotid stenting or surgical carotid endarterectomy to prevent strokes?

Evaluation of: Brott TG, Hobson RW 2nd, Howard G et al.; the CREST Investigators. Stenting versus endarterectomy for treatment of carotid-artery stenosis (CREST trial). N. Engl. J. Med. 363(1), 11–23 (2010).Stroke has a high incidence and is associated with a dramatic degree of morbidity and mortality. Carotid stenosis is responsible for approximately 20% of strokes in all patient populations, and is especially prevalent in elderly patients. Therapies to decrease the risk of stroke are urgently warranted. The first established therapy was surgical endarterectomy. Over the last few years, however, carotid artery stenting has evolved as a less invasive approach. Hitherto, the paper under evaluation (the North American Carotid Revascularization Endarterectomy versus Stenting Trial [CREST]) is the largest and most important study comparing these two treatment modalitites. The study demonstrates comparable effectiveness for carotid stenting and carotid artertectomy to reduce the risk for future strokes.