TCT2008-- CARESS: Carotid Stenting Equivalent to Carotid Endarterectomy

Key Points:
No significant differences in 30-day stroke and all-cause mortality between approaches.

By TCT Daily Staff

There was no difference between carotid artery stenting and carotid endarterectomy in rates of 30-day or four-year all-cause mortality, according to updated results from the prospective, non-randomized CARESS trial. However, carotid artery stenting did have a twofold higher restenosis rate compared with carotid endarterectomy over a four-year period.

The primary endpoint of all-cause mortality at 30 days occurred in 0.4% of those in the carotid endarterectomy group (n=254) compared with 0% in the carotid artery stenting group (n=143; P=.45). At four years, all-cause mortality occurred in 21.2% of those in the endarterectomy group compared with 18.7% in the carotid stenting group (P=.83). Four-year survival in the endarterectomy group was 79% and was 81% in the stenting group (P=.83).

At 30 days, stroke occurred in 3.6% of those in the carotid endarterectomy group compared with 2.1% in the carotid artery stenting group (P=.41). At four years, stroke occurred in 9.6% of those in the endarterectomy group compared with 8.6% in the stenting group (P=.44). There was no significant difference in freedom from stroke at four years (carotid endarterectomy 90.4% vs. carotid artery stenting 91.4%; P=.44).

MI at 30 days occurred in 0.8% of those in the carotid endarterectomy group compared with 0% in the carotid artery stenting group (P=.29). At 31 days through four years, MI occurred in 2.2% of those in the endarterectomy group compared with 1.6% of those in the stenting group (P=.63).
Combined freedom from stroke or death at four years was 73.5% for carotid endarterectomy and 78.3% for carotid artery stenting (P=.36).