Age Effect Missed in Many CREST Carotid-Treatment News Reports

from the International Stroke Conference in San Antonio 

The headline message from the CREST study reported at the stroke meeting last Friday was that two different revascularization procedures for severe carotid artery stenosis–carotid stenting and carotid endarterectomy–were equally safe and effective.  This oversimplification was true only if all of the patients undergoing these treatments were 70 years old. 

The reality was that while, on average, the two procedures had very similar results, the study also showed a powerful age effect that led to substantially different outcomes depending on patient’s age. 

Here is the graphic presented on Friday that showed this relationship: 

photo by Mitchel Zoler

The dark solid line follows the changing relationship between patient age and the relative benefit (less than 1.0) or relative harm (more than 1.0) from carotid artery stenting (CAS) compared with carotid endarterectomy (CEA). 

Patients younger than 70 who underwent stenting had fewer adverse events–the combined rate of death, stroke, or myocardial infarction–than patients who underwent carotid endarterectomy. At age 60, the relative rate of adverse events with carotid stenting was roughly 35% below that of 60-year old patients who underwent endarterectomy. At age 50, the relative rate of adverse events was cut by more than half by stenting. 

The situation flipped for patients older than 70. At age 80, patients treated by stenting had a greater than 50% higher rate of adverse events than those treated with endarterectomy. 

News reports that simply said the two treatments had similar outcomes missed this key CREST finding. 

My full report on the CREST results is here.

—Mitchel Zoler (on Twitter @mitchelzoler) 

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Filed under Cardiovascular Medicine, IMNG, Internal Medicine, Neurology and Neurological Surgery, Surgery

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