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Abstract Details

Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis: CREST-2 Update
Cerebrovascular Disease and Interventional Neurology
S53 - Stroke Prevention (5:06 PM-5:18 PM)
009
NA
Over 100,000 carotid revascularization procedures are done annually in the US for asymptomatic carotid arterial stenosis.  The safety of carotid endarterectomy (CEA) and carotid stenting (CAS), and the efficacy of medical therapy in altering the progression of atherosclerosis have improved.  Therefore, applicability of prior randomized trials to current treatment decisions has been questioned.  
The aim of the NINDS-funded CREST-2 is to compare CEA and intensive medical management (IMM) versus IMM alone (n=1240), and transfemoral CAS and IMM versus IMM alone (n=1240), through two parallel randomized clinical trials at ≈120 medical centers, including collaboration with NIH-StrokeNet.  The composite primary outcome is any stroke or death within 44 days after randomization or ipsilateral ischemic stroke thereafter up to 4 years.  A secondary outcome is cognitive function, assessed on a regular schedule through computer-assisted telephone interviews.  IMM is directed centrally and includes tight control of blood pressure (systolic target <130 mm Hg) and cholesterol (LDL target < 70 mg/dl), and lifestyle coaching.  

As of October 08, 2019, the Site Selection Committee has approved 200 sites, of which 149 have been green-lighted to open for enrollment.  129 sites have enrolled at least one patient. The Surgical and Interventional Management Committees have credentialed 412 surgeons and 190 interventionists.  An additional 115 interventionists have been approved to submit cases via the CREST-2 Companion Registry which provides a CMS-reimbursed pathway towards full credentialing in CREST-2.  1538 patients have been randomized: 811 (53%) patients in the CEA trial and 727 (47%) patients in the CAS trial.

CREST-2 is designed to identify the best approach for asymptomatic carotid stenosis.  An update will be provided regarding the numbers of patients randomized, centers certified, and fully approved surgeons and interventionists. The CREST-2 Registry provides the option of CAS while enhancing interventionists’ credentials for potential participation in CREST-2. 

Authors/Disclosures
James F. Meschia, MD, FAAN (Mayo Clinic)
PRESENTER 		The institution of Dr. Meschia has received research support from NINDS. The institution of Dr. Meschia has received research support from NINDS.
Brajesh K. Lal (University of Maryland) Brajesh K. Lal has nothing to disclose.
George Howard, PhD (UAB School of Public Hlth) Dr. Howard has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bayer.
Wayne M. Clark, MD (Oregon Health Sciences Univ) Dr. Clark has nothing to disclose.
No disclosure on file
Tanya N. Turan, MD, FAAN (Medical University of South Carolina) Dr. Turan has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Pfizer/Merck. Dr. Turan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Gore Inc. Dr. Turan has received publishing royalties from a publication relating to health care. Dr. Turan has received publishing royalties from a publication relating to health care.
No disclosure on file
Robert D. Brown, Jr., MD, MPH, FAAN (Mayo Clinic) Dr. Brown has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Craig H Neilsen Foundation. The institution of Dr. Brown has received research support from National Institutes of Health/NINDS. Dr. Brown has received publishing royalties from a publication relating to health care.
Kevin M. Barrett, MD, FAAN (Mayo Clinic) Dr. Barrett has nothing to disclose.
Seemant Chaturvedi, MD, FAHA, FAAN (University of Maryland) Dr. Chaturvedi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Astra Zeneca. Dr. Chaturvedi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for University of Calgary. Dr. Chaturvedi has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association. Dr. Chaturvedi has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Ramar & Paradiso. Dr. Chaturvedi has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Cole, Scott, Kissane. The institution of Dr. Chaturvedi has received research support from NINDS.
Marc I. Chimowitz, MD (MUSC Stroke Center) An immediate family member of Dr. Chimowitz has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Gore. Dr. Chimowitz has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NoNo Inc. The institution of Dr. Chimowitz has received research support from NIH.
Bart Demaerschalk, MD, MSc, FRCPC, FAAN (Mayo Clinic) Dr. Demaerschalk has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Demaerschalk has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Shionogi. Dr. Demaerschalk has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for The Neurologist . The institution of Dr. Demaerschalk has received research support from NICHD.
Virginia J. Howard, PhD (University of Alabama At Birmingham) The institution of Dr. Howard has received research support from NIH. The institution of an immediate family member of Dr. Howard has received research support from NIH.
No disclosure on file
Ronald M. Lazar, PhD, FAHA, FAAN, FAAN (University of Alabama At Birmingham) Dr. Lazar has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for DiaMedica Therapeutics Inc. . The institution of Dr. Lazar has received research support from National Institutes of Health. Dr. Lazar has received publishing royalties from a publication relating to health care.
No disclosure on file
Claudia Moy, PhD Claudia Moy, PhD has nothing to disclose.
Jenifer Voeks Jenifer Voeks has nothing to disclose.
Thomas G. Brott, MD, FAAN (Mayo Clinic) Dr. Brott has nothing to disclose.