Landmark Clinical Trial Compares Stroke Prevention Procedures

March 2010

For the past nine years, Drs. Elliot Chaikof, Karthik Kasirajan, Ravi Veeraswamy, Tom Dodson, and Atef Salam were participating investigators in the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST), a multi-center study conducted at 117 centers in the United States and Canada. One of the largest randomized stroke prevention trials ever, the study compared two medical procedures designed to prevent future strokes and found both to be safe and effective overall. The findings were recently presented at the International Stroke Conference in San Antonio.

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). "This landmark study shows that surgery and stenting are safe and effective for people with carotid artery disease," says Dr. Chaikof. "Each modality offers its own advantages and limitations — with stenting the risk of stroke was slightly higher, particularly in patients over 70, but the risk of myocardial infarction was higher with surgery. Such knowledge gives physicians more options to customize treatment for patients at risk for stroke."

One of the strengths of the study, according to investigators, was that CREST was conducted in a variety of real world settings, including large and small public and private hospitals. Physicians had to demonstrate a high degree of proficiency and safety in order to participate in the trial. The study found no significant differences in the outcomes, no matter what type of medical specialist performed the stenting procedure, including cardiologists, neuroradiologists, interventional radiologists, vascular surgeons and neurosurgeons.

"The rate of stroke and death for both procedures was the lowest ever reported in a large stroke prevention trial," says Dr. Chaikof, "which I believe testifies to the significant advances in technology, technique and patient selection that have continued over the eight-year enrollment in CREST."

The study was funded by the National Institute of Neurological Disorders and Stroke, part of the National Institutes of Health.