Carotid Stenting vs. Endarterectomy for Carotid Stenosis
(CREST-2 Trial)
What You Need to Know Before You Apply
What is the purpose of this trial?
Carotid revascularization for primary prevention of stroke (CREST-2) is two independent multicenter, randomized controlled trials of carotid revascularization and intensive medical management versus medical management alone in patients with asymptomatic high-grade carotid stenosis. One trial will randomize patients in a 1:1 ratio to endarterectomy versus no endarterectomy and another will randomize patients in a 1:1 ratio to carotid stenting with embolic protection versus no stenting. Medical management will be uniform for all randomized treatment groups and will be centrally directed.
Will I have to stop taking my current medications?
The trial protocol does not specify if you need to stop taking your current medications. However, if you are on certain anticoagulants like warfarin or have a history of intolerance to study medications, you may not be eligible to participate.
Is carotid stenting or endarterectomy safe for humans?
Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are generally considered safe, but the risk of complications can vary. Some studies suggest a higher risk of adverse events with CAS, especially in low-volume centers, while CEA is the standard treatment with known risks. Both procedures have been studied extensively, and understanding individual risk factors can help reduce the risk of stroke or death.12345
How does the treatment for carotid stenosis differ from other treatments?
Carotid endarterectomy (CEA) is the standard treatment for carotid stenosis, especially for patients with significant blockage, while carotid artery stenting (CAS) is an alternative for those at high surgical risk or with challenging anatomy. CEA involves surgically removing plaque from the artery, whereas CAS uses a stent to keep the artery open, offering a less invasive option.23567
What data supports the effectiveness of the treatment Carotid endarterectomy (CEA) and Carotid Stenting (CAS) for Carotid Stenosis?
Who Is on the Research Team?
George Howard, DrPH
Principal Investigator
University of Alabama at Birmingham
Lloyd Edwards, PhD
Principal Investigator
University of Alabama at Birmingham
Brajesh K. Lal, MD
Principal Investigator
University of Maryland
James F. Meschia, MD
Principal Investigator
Mayo Clinic
Are You a Good Fit for This Trial?
This trial is for adults over 35 with asymptomatic high-grade carotid stenosis, who haven't had a stroke or TIA related to the stenosis in the last 180 days. They must be able to follow the study schedule and not be pregnant if of childbearing potential. Exclusions include recent major surgery, severe kidney disease, planned major surgeries, certain cancers, and intolerance to study medications.Inclusion Criteria
Exclusion Criteria
Timeline for a Trial Participant
Screening
Participants are screened for eligibility to participate in the trial
Treatment
Participants receive either carotid endarterectomy, carotid stenting, or intensive medical management
Follow-up
Participants are monitored for stroke and cognitive function outcomes
What Are the Treatments Tested in This Trial?
Interventions
- Carotid endarterectomy (CEA)
- Carotid Stenting (CAS)
- Intensive Medical Management - no CAS
- Intensive Medical Management - no CEA
Find a Clinic Near You
Who Is Running the Clinical Trial?
Mayo Clinic
Lead Sponsor
Thomas G. Brott, M.D.
Lead Sponsor
National Institute of Neurological Disorders and Stroke (NINDS)
Collaborator