July 13, 2010
A major study of people at risk for stroke, conducted in part at CAMC, showed that two medical procedures designed to prevent future strokes are safe and effective overall. Physicians will now have more options in tailoring treatments for their patients at risk for stroke. 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. CAS involves threading a stent and expanding a small protective device in the artery to widen the blocked area and capture any dislodged plaque. One of the largest randomized stroke prevention trials ever, the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST) took place at CAMC along with 116 other centers in the United States and Canada during a nine-year period. CREST compared the safety and effectiveness of CEA and CAS in patients with or without a previous stroke. The trial was funded by the National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health. “Carotid stenting has matured significantly since we did our first case in West Virginia 15 years ago,” said Mark Bates, MD. “It was an honor for our site to be invited to participate in this landmark study and we were encouraged with the findings. We have been involved in many other carotid stent trials and Dr. Ali AbuRahma has led several landmark carotid surgical trials. Presently we use this collective experience to advise patients about surgery versus stenting and our recommendations have not changed significantly with the CREST results, but unlike many centers our stent program is very mature. The trial will clearly impact many centers that currently don’t offer both options.” 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. Investigators found some differences. There were more heart attacks in patients who had surgery versus a stent and stents were slightly better for people age 69 and younger. For patients 70 and older, surgery was slightly better. Stroke, the third leading cause of death in the United States, is caused by an interruption in blood flow to the brain by a clot or bleeding. The carotid arteries on each side of the neck are the major source of blood flow to the brain. The buildup of cholesterol in the wall of the carotid artery, called atherosclerotic plaque, is one cause of stroke. Because people with carotid atherosclerosis also usually have atherosclerosis in the coronary arteries that supply the heart, the CREST trial tracked the rate of heart attacks, in addition to stroke and death.

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