A long-term follow-up study of CREST shows that patients who received a stent are no more likely to have a stroke than healthy patients of the same age.
Initial results for CREST were reported in 2010 and led to the FDA approving the Acculink carotid stent manufactured by Abbott Vascular. Results of this latest study were published in The New England Journal of Medicine.
Study shows that stenting is an effective treatment option
Stents are are narrow tubes inserted into arteries, designed to keep them open and facilitate the flow of blood. The medical community continues to debate whether the method is effective at reducing the incidence of strokes.
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Another study showed that stenting performs as well as surgery for asymptomatic patients, and that results were good for 5 years. The latest CREST study included both symptomatic and asymptomatic patients.
However it is important to note that the studies are based on now outdated ideas of medical management from the 1980s. Lifestyle interventions are now far more common, including smoking cessation, diet advice and exercise routines.
Although both CREST and the ACT-1 study showed that stenting was not inferior to surgery, they also showed that stent patients suffered an increased amount of early events such as minor strokes.
Future stent study will enable more informed medical conclusions
It is thought that the CREST 2 study could throw more light on the issue. Around 70 centers are involved so far, with around 200 patients signed up to the study. Experts believe that the study could break new ground and pit medical cardiologists against interventionalists in the ongoing debate over the merits of stenting.
Mark Alberts, MD, of UT Southwestern Medical Center in Dallas, who is a spokesperson for the American Stroke Association, said that the results of CREST and ACT-1 show that stenting is a viable option. However he did say that medical management should be investigated.
CREST involved 2,502 patients, including 47.2% who were asymptomatic. 1,607 of them, of which 52.5% were asymptomatic, took part in the 10-year follow-up. Doctors are now eagerly awaiting the results of CREST 2 in order to reach more informed conclusions about the benefits of inserting a stent versus medical management.