CREST was the largest prospective randomized trial to date comparing carotid endarterectomy and carotid artery stenting , enrolling 2502 patients from 117 US and Canadian centers.

For the composite primary endpoint of any stroke, myocardial infarction (MI), or death during the periprocedural period or ipsilateral stroke on follow-up, stenting was associated with a 7.2% rate of these events vs 6.8% with surgery, a nonsignificant difference.

At 30 days, the rate of stroke was significantly higher with stenting at 4.1%, vs 2.3% with surgery, although major stroke was not different at less than 1% in both groups.

Conversely, MI was higher with CEA at 2.3% vs 1.1% with stenting, again a statistical difference. Patients who had an MI, though, reported a better quality of life after recovery than those who had a stroke, the study authors noted.