• About
  • Masthead
  • License Content
  • Advertise
  • Submit Press Release
  • RSS/Email List
  • 2MM Podcast
  • Write for us
  • Contact Us
2 Minute Medicine
No Result
View All Result

No products in the cart.

SUBSCRIBE
  • Specialties
    • All Specialties, All Recent Reports
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Pharma
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • AI Roundup
  • Pharma
  • The Scan+
  • Classics™+
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Podcasts
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • Account
    • Subscribe
    • Sign-in
    • My account
2 Minute Medicine
  • Specialties
    • All Specialties, All Recent Reports
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Pharma
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • AI Roundup
  • Pharma
  • The Scan+
  • Classics™+
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Podcasts
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • Account
    • Subscribe
    • Sign-in
    • My account
SUBSCRIBE
2 Minute Medicine
Subscribe
Home All Specialties Cardiology

Use of carotid artery stenting increased amongst older patients in the US despite results from CREST trial

byJames EnglandandAnees Daud
December 12, 2017
in Cardiology, Chronic Disease, Emergency, Imaging and Intervention, Neurology, Public Health, Surgery
Reading Time: 2 mins read
0
Share on FacebookShare on Twitter

1. In this analysis of treatment patterns in the United States for the years prior to, and following, the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST), the use of carotid artery stenting (CAS) rose amongst patients 70 years and older despite the evidence for worse outcomes.

2. The increase in utilization of CAS also rose in women, who were shown to have increased risk of periprocedural complications with CAS in the CREST study.

Evidence Rating Level: 3 (Average)    

Study Rundown: The CREST study published in 2010 compared the use of CAS with carotid endarterectomy (CEA) in patients with severe carotid artery stenosis and demonstrated no differences in primary endpoint between the two strategies. However, in subgroup analysis age and sex were found to be important factors in outcome. Patients older than 70 years had better outcome with CEA, while younger patients fared better with CAS. Risk of periprocedural complications was higher for women undergoing CAS than with men. How the results of CREST influenced practice patterns is not certain. The current study evaluated the use of CAS amongst adults older than 70 years in the United States during the 3 years before and after the CREST study. The investigation found that despite the results of the CREST study the use of CAS increased amongst older patients, including women.

The current study highlights continued practice patterns despite evidence from ongoing clinical trials. The main confounders would include the variable interpretations of the results of the CREST trial, as it compares to the favorability of CAS in other studies. Developments of newer stenting technologies may also influence treatment decisions. The main limitations of the study include the retrospective design, and reliance on diagnostic codes and the lack of data on important factors that may influence treatment decisions such as important patient comorbidities.

Click to read the study, published in JAMA Neurology

RELATED REPORTS

Impaired lipoprotein cholesterol ratio is associated with cognitive impairment in patients with stroke

Personalized visual perceptual learning digital therapy may improve vision post-stroke

Delayed alteplase has clinical benefits in posterior circulation stroke outcomes

Relevant Reading: Long-Term Results of Stenting versus Endarterectomy for Carotid-Artery Stenosis

In-Depth [retrospective cohort]: This study included data from Nationwide Inpatient Sample (NIS) database, using data from 2007-2010 (pre-CREST) and 2011-2014 (post-CREST) which is a 20% random sample of all discharges in the United States. Patients were included if they were 70 years or older, and were undergoing carotid revascularization, identified using International Classification of Diseases, Ninth Revision (ICD-9) procedural codes.

During the study period there were 494 733 carotid revascularization procedures performed on adults 70 years or older. Of these patients 87.2% underwent CEA and 12.8% underwent CAS. The proportion of patients undergoing CAS during the pre-CREST period was 11.9%, while it was 13.8% in the post-CREST period (p = 0.005). The odds of receiving CREST increased by 13% during this period (odds ratio [OR], 1.13, 95%CI, 1.00-1.28, p = 0.04). This increase in odds of CAS was also observed amongst women (OR, 1.31, 1.05-1.65, p = 0.02).

Image: CC/Wiki

©2017 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.

Tags: carotid stenosisstentingstroke
Previous Post

Individualized glycemic control for type 2 diabetes may save the U.S. billions annually

Next Post

Paternal SSRI usage correlates with increased ADHD rate in offspring

RelatedReports

Quick Take: Functional Outcome of Intravenous Thrombolysis in Patients With Lacunar Infarcts in the WAKE-UP Trial
Chronic Disease

Impaired lipoprotein cholesterol ratio is associated with cognitive impairment in patients with stroke

June 4, 2025
Non-alcoholic fatty liver disease and risk of incident acute myocardial infarction and stroke: findings from matched cohort study of 18 million European adults
Chronic Disease

Personalized visual perceptual learning digital therapy may improve vision post-stroke

May 30, 2025
Stroke expansion following intra-arterial therapy may explain worse outcomes
Emergency

Delayed alteplase has clinical benefits in posterior circulation stroke outcomes

May 30, 2025
Quick Take: Functional Outcome of Intravenous Thrombolysis in Patients With Lacunar Infarcts in the WAKE-UP Trial
Chronic Disease

Low-frequency electrical stimulation effective for stimulation of the wrist extensors in patients after stroke

May 24, 2025
Next Post
Antidepressant use associated with increased risk of subsequent mania

Paternal SSRI usage correlates with increased ADHD rate in offspring

Variability in interpretation of breast biopsy slides associated with low verification of atypia and ductal carcinoma in situ

2 Minute Medicine Rewind December 11, 2017

Computed tomography improves diagnostic certainty in the emergency department

Collaboration between EMS and primary care physicians could reduce unnecessary emergency transport for fallen seniors

2 Minute Medicine® is an award winning, physician-run, expert medical media company. Our content is curated, written and edited by practicing health professionals who have clinical and scientific expertise in their field of reporting. Our editorial management team is comprised of highly-trained MD physicians. Join numerous brands, companies, and hospitals who trust our licensed content.

Recent Reports

  • 2 Minute Medicine Rewind June 16, 2025
  • Transcatheter closure of patent ductus arteriosus demonstrates similar outcomes compared to surgical repair
  • #VisualAbstract: Encorafenib, Cetuximab, and mFOLFOX6 Improves Survival in BRAF-Mutated Colorectal Cancer
License Content
Terms of Use | Disclaimer
Cookie Policy
Privacy Statement (EU)
Disclaimer

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.

  • Specialties
    • All Specialties, All Recent Reports
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Pharma
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • AI Roundup
  • Pharma
  • The Scan
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Podcasts
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • Account
    • Subscribe
    • Sign-in
    • My account
No Result
View All Result

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.