March 1, 2010 — Researchers at the University of Virginia Health System played a significant role in a national landmark study comparing two treatments designed to prevent stroke in those at risk. The findings from an initial analysis of the Carotid Revascularization Endarterectomy vs. Stenting Trial, or CREST, were announced this morning at the International Stroke Conference in San Antonio.
The analysis shows that carotid endarterectomy, a surgical procedure that clears blocked blood flow, is as safe and effective as carotid artery stenting, a newer and less invasive procedure that uses a stent to insert and widen a device that opens a blocked area and captures plaque.
According to Dr. Avery J. Evans, associate professor of radiology and neurosurgery at U.Va. Health System and lead site investigator, the real wins are for area patients who have more proven options to prevent new or future strokes.
"The results of this trial should not be interpreted to mean that carotid stenting is ready to be rapidly adopted as a standard practice at every hospital," he said. "The centers that participated in the trial were all highly selected and had proven that they had special expertise and low complication rates with carotid stenting. Other studies have shown that carotid stenting can be more dangerous than CEA if the operators lack special training."
In the trial, 2,502 men and women received one of the two procedures. Some of the participants had experienced previous minor strokes while others had not, but had showed a narrowing of their carotid arteries. The efficacy and safety of both treatments was roughly the same, with some notable differences. When investigators observed the numbers of heart attacks and strokes, they found there were more heart attacks in the group that received the carotid endarterectomy surgical procedure and more strokes in those who received carotid artery stenting.
The investigators also found that age mattered. Those under 69 had slightly better results with carotid artery stenting and those over 70 had better results with carotid endarterectomy.
"With our expertise and ability to deliver leading care across the spectrum, as well as our active leadership in the field by participating in trials such as this one, patients will receive better targeted care based on their particular needs," Evans said.
U.Va. Health System was one of 117 centers in the United States and Canada to participate in the trial over a nine-year period. It was the only participating center in Virginia.
Stroke is the third-leading cause of death and disability in the United States. It is caused by a blockage of blood flow to the brain. The carotid arteries, which are on the sides of the neck, are the primary source of blood to the brain.
CREST was funded by the National Institutes of Neurologic Disorders, a part of the National Institutes of Health. Partial funding also came from Abbot, in Abbot Park, Ill., which makes stents. The national study was led by investigators at the Mayo Clinic and the University of Medicine and Dentistry of New Jersey.