Christiana Care participated in a landmark clinical trial that showed for people at risk for stroke two medical procedures designed to prevent future strokes are safe and effective. As a result of the study, physicians now have more options in tailoring treatments for patients at risk for stroke.
One of the largest randomized stroke prevention trials ever, the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST) took place over a nine-year period at 117 centers in Canada and the United States, including Christiana Care’s Center for Heart & Vascular Health. In the trial of 2,502 participants, carotid endarterectomy (CEA), a surgical procedure to clear blocked blood flow and considered the gold standard prevention treatment, was compared to carotid artery stenting (CAS), a newer and less invasive procedure that involves threading a stent and expanding a small protective device in the artery to widen the blocked area and capture any dislodged plaque.
The overall safety and efficacy of the two procedures was largely the same with equal benefits for both men and for women, and for patients who had previously had a stroke and for those who had not. However, when the investigators looked at the numbers of heart attacks and strokes, they found differences. The investigators found that there were more heart attacks in the surgical group, 2.3 percent compared to 1.1 percent in the stenting group; and more strokes in the stenting group, 4.1 percent versus 2.3 percent for the surgical group in the weeks following the procedure.
“Vascular surgeons along with interventional cardiologists and radiologists at the Center for Heart and Vascular Health participated and enrolled patients in the CREST Trial,” says Tim Gardner, M.D., medical director. “Having this multi-disciplinary capability here will serve future patients well. The principal finding of CREST is that the choice of treatment must be individualized for each patient with carotid disease. Our cardiovascular specialists will be able to perform either traditional surgical carotid endarterectomy or carotid stenting using whichever treatment is most appropriate for the particular patient.”
The trial was funded by the National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health, and led by investigators at Mayo Clinic, Jacksonville, Fla., and the University of Medicine and Dentistry of New Jersey in Newark.
For more information on the trail, read the press release from the National Institutes of Health.