Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST): current and future implications for carotid artery stenting

Current reimbursement guidelines from the Centers for Medicare & Medicaid Services, prior to the publication of the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST) results, reserve carotid artery stenting for stenosis in patients who are symptomatic, with severe stenosis, and considered high risk for carotid endarterectomy (CEA). CREST is a prospective, multicenter, randomized controlled trial, which compared surgical endarterectomy to endovascular stenting with primary end points of periprocedural stroke, myocardial infarction, or death or postprocedural ipsilateral stroke up to 4 years in standard-risk patients. CREST results indicate that stenting may be equal to CEA. Overall, the trial demonstrated fewer strokes in the CEA group, with a lower risk of myocardial infarction associated with carotid artery stenting. The study suggests that younger patients may actually have improved outcomes with stenting, whereas CEA may be superior for older patients.