Carotid revascularization and medical management for asymptomatic carotid stenosis: Protocol of the CREST-2 clinical trials

Rationale Trials conducted decades ago demonstrated that carotid endarterectomy by skilled surgeons reduced stroke risk in asymptomatic patients. Developments in carotid stenting and improvements in medical prevention of stroke caused by atherothrombotic disease challenge understanding of the benefi...

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Bibliographic Details
Published in:International Journal of Stroke 2017-10, Vol.12 (7), p.770-778
Main Authors: Howard, Virginia J, Meschia, James F, Lal, Brajesh K, Turan, Tanya N, Roubin, Gary S, Brown, Robert D, Voeks, Jenifer H, Barrett, Kevin M, Demaerschalk, Bart M, Huston, John, Lazar, Ronald M, Moore, Wesley S, Wadley, Virginia G, Chaturvedi, Seemant, Moy, Claudia S, Chimowitz, Marc, Howard, George, Brott, Thomas G
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Carotid Stenosis - complications
Carotid Stenosis - surgery
Cognition
Endarterectomy, Carotid
Female
Humans
Male
Middle Aged
Risk
Stroke - etiology
Stroke - prevention & control
Treatment Outcome
United States
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Summary:Rationale Trials conducted decades ago demonstrated that carotid endarterectomy by skilled surgeons reduced stroke risk in asymptomatic patients. Developments in carotid stenting and improvements in medical prevention of stroke caused by atherothrombotic disease challenge understanding of the benefits of revascularization. Aim Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial (CREST-2) will test whether carotid endarterectomy or carotid stenting plus contemporary intensive medical therapy is superior to intensive medical therapy alone in the primary prevention of stroke in patients with high-grade asymptomatic carotid stenosis. Methods and design CREST-2 is two multicenter randomized trials of revascularization plus intensive medical therapy versus intensive medical therapy alone. One trial randomizes patients to carotid endarterectomy plus intensive medical therapy versus intensive medical therapy alone; the other, to carotid stenting plus intensive medical therapy versus intensive medical therapy alone. The risk factor targets of centrally directed intensive medical therapy are LDL cholesterol
ISSN:1747-4930
1747-4949
DOI:10.1177/1747493017706238