Embolic protection, new stents, and TCAR are narrowing the gap between CAS and CEA, but medical therapy could still hold its own in CREST-2.
HOLLYWOOD, FL—Carotid artery stenting (CAS) and endarterectomy (CEA) remain neck and neck in vying for prominence, but some experts say a minimally invasive surgical approach known as transcarotid artery revascularization (TCAR), as well as new filters and devices that aim to cut the risk of minor stroke with stenting, could well shift the balance away from surgery.
Moreover, still-pending results from the CREST-2 trial will clarify the position of medical therapy compared with revascularization.
“We were running a little bit behind milestones, and I think right now we’re about right at milestones in terms of achieving the actual enrollment,” Barry T. Katzen, MD (Miami Cardiac & Vascular Institute, FL), reported at the 2019 International Symposium on Endovascular Therapy (ISET). “So this trial is moving along quite well, just slightly below the projected accrual rate. Interestingly enough, endarterectomy was lagging behind stenting in terms of accrual, but now it’s pretty much 50-50, which is great news for the ultimate statistical analysis of this trial.”
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1NEWSISET 2019Surmounting Minor Stroke: New Devices, TCAR Aim to Cut Risk of Carotid Artery Stenting