Issues to Be Addressed and Hopefully Resolved in the Carotid Revascularization Endarterectomy Versus Stenting Trial 2

Angiology ◽  
2015 ◽  
Vol 67 (5) ◽  
pp. 408-410 ◽  
Author(s):  
Wesley S. Moore
Keyword(s):  
Carotid Artery ◽  
Medical Treatment ◽  
Stroke Prevention ◽  
Carotid Artery Stenting ◽  
Controlled Trials ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid ◽  
Carotid Revascularization ◽  
Randomized Controlled ◽  
Best Medical Treatment

The superiority of carotid endarterectomy (CEA) plus best medical treatment (BMT) over BMT alone for the management of patients with asymptomatic carotid stenosis is based on randomized controlled trials that recruited patients up to 30 years ago. Best medical treatment has improved considerably since that time with respect to stroke prevention. Furthermore, a new carotid intervention has emerged during the last 2 decades and has gradually become established, that is, carotid artery stenting (CAS). Consequently, the efficacy of current BMT alone needs to be compared not only with CEA plus BMT but also with CAS plus BMT to determine which strategy achieves the optimal stroke prevention rates. This article highlights the purpose of the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) 2 and discusses the issues that CREST-2 will hopefully provide answers to.

scholarly journals The CREST-2 experience with the evolving challenges of COVID-19

Neurology ◽  
2020 ◽  
Vol 95 (1) ◽  
pp. 29-36 ◽  
Author(s):  
James F. Meschia ◽  
Kevin M. Barrett ◽  
Robert D. Brown ◽  
Tanya N. Turan ◽  
Virginia J. Howard ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Medical Management ◽  
Neurological Disorders ◽  
Stroke Prevention ◽  
Prevention Trial ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid ◽  
Ethical Obligation ◽  
Carotid Revascularization

The coronavirus disease 2019 pandemic has disrupted the lives of whole communities and nations. The multinational multicenter National Institute of Neurological Disorders and Stroke Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial stroke prevention trial rapidly experienced the effects of the pandemic and had to temporarily suspend new enrollments and shift patient follow-up activities from in-person clinic visits to telephone contacts. There is an ethical obligation to the patients to protect their health while taking every feasible step to ensure that the goals of the trial are successfully met. Here, we describe the effects of the pandemic on the trial and steps that are being taken to mitigate the effects of the pandemic so that trial objectives can be met.

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