Age and outcomes after carotid stenting and endarterectomy: The Carotid Revascularization Endarterectomy Versus Stenting Trial

Jenifer H. Voeks, George Howard, Gary S. Roubin, Mahmoud B. Malas, David J. Cohen, W. Charles Sternbergh, Herbert D. Aronow, Mark K. Eskandari, Alice J. Sheffet, Brajesh K. Lal, James F. Meschia, Thomas G. Brott

Research output: Contribution to journalArticlepeer-review

Abstract

Background and Purpose: High stroke event rates among carotid artery stenting (CAS)-treated patients in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST) lead-in registry generated an a priori hypothesis that age may modify the relative efficacy of CAS versus carotid endarterectomy (CEA). In the primary CREST report, we previously noted significant effect modification by age. Here we extend this investigation by examining the relative efficacy of the components of the primary end point, the treatment-specific impact of age, and contributors to the increasing risk in CAS-treated patients at older ages. Methods: Among 2502 CREST patients with high-grade carotid stenosis, proportional hazards models were used to examine the impact of age on the CAS-to-CEA relative efficacy, and the impact of age on risk within CAS-treated and CEA-treated patients. Results: Age acted as a treatment effect modifier for the primary end point (P interaction=0.02), with the efficacy of CAS and CEA approximately equal at age 70 years. For CAS, risk for the primary end point increased with age (P

Original languageEnglish (US)
Pages (from-to)3484-3490
Number of pages7
JournalStroke
Volume42
Issue number12
DOIs
StatePublished - Dec 2011

Keywords

  • Carotid artery
  • Carotid endarterectomy
  • Cerebrovascular disease
  • Stents
  • Vascular surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing

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