To compare health-related quality of life (HRQOL) outcomes in patients treated with carotid artery stenting (CAS) versus carotid endarterectomy (CEA).
In CREST, the largest randomized trial of carotid revascularization to date, there was no significant difference in the primary composite endpoint but rates of stroke and MI differed between CAS and CEA. To help guide individualized clinical decision-making, we compared HRQOL among patients enrolled in CREST. We also performed exploratory analyses to evaluate the association between periprocedural complications and HRQOL.
We measured HRQOL at baseline, and after 2-weeks, 1-month, and 1-year among 2502 patients randomized to either CAS or CEA in CREST. HRQOL was assessed using the Medical Outcomes Study Short-Form 36 (SF-36) and 6 disease-specific scales designed to study HRQOL in patients undergoing carotid revascularization.
At both 2-weeks and 1-month, CAS patients had better outcomes for multiple components of the SF-36, with large differences for role physical function, pain, and the physical component summary scale (all p<0.01). On the disease-specific scales, CAS patients reported less difficulty with driving, eating/swallowing, neck pain, and headaches but more difficulty with walking and leg pain (all p<0.05). However, by 1 year there were no differences in any HRQOL measure between CAS and CEA. In the exploratory analyses, periprocedural stroke was associated with poorer 1-year HRQOL across all SF-36 domains, but periprocedural MI or cranial nerve palsy were not.
Among patients undergoing carotid revascularization, CAS is associated with better HRQOL during the early recovery period as compared with CEA—particularly with regard to physical limitations and pain—but these differences diminish over time and are not evident after 1-year. Although CAS and CEA are associated with similar overall HRQOL at 1-year, event-specific analyses confirm that stroke has a greater and more sustained impact on HRQOL than MI.