CREST-2: Identifying the Best Method of Stroke Prevention for Carotid Artery Stenosis

Mott, Meghan; Koroshetz, Walter J.; Wright, Clinton B.

doi:10.1161/strokeaha.117.016051

Cited by 65 publications

(29 citation statements)

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“…Three RCTs are currently recruiting patients [ 134 ]. CREST-2 will separately test CEA and CAS for asymptomatic ICA stenosis versus BMT [ 135 ]. Asymptomatic Carotid Surgery Trial 2 (ACST-2) will directly compare CEA to CAS for asymptomatic ICA stenosis [ 136 ].…”

Section: Asymptomatic Extracranial Carotid Diseasementioning

confidence: 99%

Recent Advances in Primary and Secondary Prevention of Atherosclerotic Stroke

et al. 2018

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Atherosclerosis is a major cause of ischemic stroke that can be effectively prevented with appropriate lifestyle modifications and control of cardiovascular risk factors. Medical advances in recent years along with aggressive cardiovascular risk factor modifications have resulted in decreased recurrence rates of atherosclerotic stroke. Non-statin lipid-lowering molecules have recently shown clinical benefit and are recommended for very high-risk patients to reduce their risk of stroke. Aggressive hypertension treatment is crucial to reduce atherosclerotic stroke risk. Advances in antithrombotic treatments include combinations of antiplatelets and new antiplatelet agents in the acute phase post-stroke, which carries a high risk of recurrence. Intensive medical treatment has also limited the indications for carotid interventions, especially for asymptomatic disease. Intracranial atherosclerotic disease may provoke stroke through various mechanisms; it is increasingly recognized as a cause of ischemic stroke with advanced imaging and is best managed with lifestyle modifications and medical therapy. The diagnostic search for the vulnerable culprit atherosclerotic plaque is an area of intense research, from the level of the intracranial arteries to that of the aortic arch. Ultrasonography and novel magnetic resonance imaging techniques (high-resolution vessel-wall imaging) may assist in the identification of vulnerable atherosclerotic plaques as the underlying cause in cryptogenic or misdiagnosed non-atherosclerotic ischemic stroke. Vertebrobasilar atherosclerotic disease is less common than carotid artery disease; thus, high-quality data on effective prevention strategies are scarcer. However, aggressive medical treatment is also the gold standard to reduce cerebrovascular disease located in posterior circulation.

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Section: Asymptomatic Extracranial Carotid Diseasementioning

confidence: 99%

Recent Advances in Primary and Secondary Prevention of Atherosclerotic Stroke

et al. 2018

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“…For the first time, this topic has been mentioned in the guidelines of the European Society for Vascular Surgery [7] as well. While the results from controlled randomised CREST-2 trial are awaited in years to come [8], the current study demonstrates not only the change in cognitive function, depressive symptoms and HRQoL after revascularisation but also the change in the Best Medical Treatment (BMT) group in patients with severe carotid stenosis.…”

Section: Introductionmentioning

confidence: 91%

Changes in Cognition, Depression and Quality of Life after Carotid Stenosis Treatment

Pūcīte

Krievina

Miglāne

et al. 2019

CNR

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Background: Although several studies have evaluated the change of cognitive performance after severe carotid artery stenosis, the results still remain elusive. The objective of this study was to assess changes in cognitive function, depressive symptoms and Health Related Quality of Life (HRQoL) after carotid stenosis revascularisation and Best Medical Treatment (BMT).Methods: Study involved 213 patients with ≥70% carotid stenosis who underwent assessment of cognitive function using Montreal Cognitive Assessment scale (MoCA), depressive symptoms - using Patient Health Questionnaire-9 (PHQ-9) and HRQoL - using Medical Outcome Survey Short Form version 2 (SF-36v2). The assessment was performed before and at 6 and 12 months follow-up periods in patients who had Carotid Endarterectomy (CEA), Carotid Artery Stenting (CAS) or received BMT only.Results: Improvement in the total MoCA scores was observed after 6 and 12 months (p<0.001, Kendall's W=0.28) in the CEA group. In the CAS group - after 12 months (p=0.01, Kendall's W=0.261) whereas in the BMT group - no significant changes (p=0.295, Kendall's W=0.081) were observed. Reduction of depressive symptoms was not found in any of the study groups. Comparing mean SF-36v2 scores in the CEA group, there was no significant difference in any of 10 subscales. Likewise in the CAS group - no significant difference in 9 of 10 subscales (p=0.028, η2=0.343) was observed. Three subscales worsened in the BMT group during the 1-year follow-up period.Conclusion: Patients with severe carotid stenosis who underwent revascularisation enhanced their cognitive performance without exerting significant change of depressive symptoms. Preoperative HRQoL may be maintained for at least one year in the CEA group.

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“…that makes them at “higher risk for stroke” on BMT is recommended [ 5 , 7 , 22 ]. The Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial (CREST-2) is designed to further refine the treatment of asymptomatic patients with high-grade carotid artery stenosis [ 23 ], but its final results are still several years away. Nowadays, in case of proximal CCA stenosis, open retrograde stenting is increasingly frequently applied because it minimizes the chance of intraoperative complications and embolic events during and after the procedure [ 7 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

Middle and Distal Common Carotid Artery Stenting: Long-Term Patency Rates and Risk Factors for In-Stent Restenosis

Vértes

Nguyen

Székely

et al. 2020

Cardiovasc Intervent Radiol

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Purpose In the absence of literature data, we aimed to determine the long-term patency rates of middle/distal common carotid artery (CCA) stenting and to investigate predisposing factors in the development of in-stent restenosis (ISR). Materials and Methods Fifty-one patients (30 males, median age 63.5 years), who underwent stenting with 51 self-expandable stents for significant (≥ 60%) stenosis of the middle/distal CCA, were analyzed retrospectively. Patient (atherosclerotic risk factors, comorbidities, medications), vessel (elongation), lesion (stenosis grade, length, calcification, location), and stent characteristics (material, diameter, length, fracture) were examined. Duplex ultrasonography was used to monitor stent patency. The Mann–Whitney U and Fisher’s exact tests, Kaplan–Meier analyses, and a log-rank test were used statistically. Results The median follow-up time was 35 months (interquartile range, 20–102 months). Significant (≥ 70%) ISR developed in 14 patients (27.5%; stenosis, N = 10; entire CCA occlusion, N = 4). Primary patency rates were 98%, 92%, 83%, 73%, and 61% at 6, 12, 24, 60, and 96 months, respectively. Reintervention was performed in six patients (11.8%) with nonocclusive ISR. Secondary patency rates were 100% at 6 and 12 months and 96% at 24, 60, and 96 months. In-stent restenosis developed more frequently ( P < .001) in patients with hyperlipidemia; primary patency rates were also significantly worse (Chi-square, 11.08; degrees of freedom, 1; P < .001) in patients with hyperlipidemia compared to those without. Conclusion Stenting of the middle/distal CCA can be performed with acceptable patency rates. If intervention is unequivocally needed, patients with hyperlipidemia will require closer follow-up care. Level of Evidence Level 3, Local non-random sample.

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CREST-2: Identifying the Best Method of Stroke Prevention for Carotid Artery Stenosis

Cited by 65 publications

References 0 publications

Recent Advances in Primary and Secondary Prevention of Atherosclerotic Stroke

Recent Advances in Primary and Secondary Prevention of Atherosclerotic Stroke

Changes in Cognition, Depression and Quality of Life after Carotid Stenosis Treatment

Middle and Distal Common Carotid Artery Stenting: Long-Term Patency Rates and Risk Factors for In-Stent Restenosis

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