Quality Assurance for Carotid Stenting in the CREST-2 Registry

Brajesh K. Lal, Gary S. Roubin, Kenneth Rosenfield, Donald Heck, Michael Jones, Brian Jankowitz, Tudor Jovin, Seemant Chaturvedi, Guilherme Dabus, Christopher J. White, William Gray, Jon Matsumura, Barry T. Katzen, L. Nelson Hopkins, Minerva Mayorga-Carlin, John D. Sorkin, George Howard, James F. Meschia, Thomas G. Brott

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: The CREST-2 Registry (C2R) was approved by National Institute of Neurological Disorders and Stroke–National Institutes of Health in September 2014 with Centers for Medicare & Medicaid Services, U.S. Food and Drug Administration, and industry collaboration to enroll patients undergoing CAS. The registry credentials interventionists and promotes optimal patient selection, procedural-technique, and outcomes. Objectives: This study reports periprocedural outcomes in a cohort of carotid artery stenting (CAS) performed for asymptomatic and symptomatic carotid stenosis. Methods: Asymptomatic patients with ≥70% and symptomatic patients with ≥50% carotid stenosis, ≤80 years of age, and at standard or high risk for carotid endarterectomy are eligible for enrollment. Interventionists are credentialed by a multispecialty committee that reviews experience, lesion selection, technique, and outcomes. The primary endpoint was a composite of stroke and death (S/D) in the 30-day periprocedural period. Myocardial infarction and access-site complications were assessed as secondary outcomes. Results: As of December 2018, 187 interventionists from 98 sites in the United States performed 2,219 CAS procedures in 2,141 patients with primary atherosclerosis (78 were bilateral). The mean age of the cohort was 68 years, 65% were male, and 92% were white; 1,180 (55%) were for asymptomatic disease, and 961 (45%) were for symptomatic disease. All U.S. Food and Drug Administration–approved stents and embolic protection devices were represented. The 30-day rate of S/D was 1.4% for asymptomatic, 2.8% for symptomatic, and 2.0% for all patients. Conclusions: C2R is the first national registry for CAS cosponsored by federal and industry partners. CAS was performed by experienced operators using appropriate patient selection and optimal technique. In that setting, a broad group of interventionists achieved very low periprocedural S/D rates for asymptomatic and symptomatic patients.

Original languageEnglish (US)
Pages (from-to)3071-3079
Number of pages9
JournalJournal of the American College of Cardiology
Volume74
Issue number25
DOIs
StatePublished - Dec 24 2019

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Registries
Carotid Arteries
Carotid Stenosis
Stroke
Patient Selection
Embolic Protection Devices
Food Services
Asymptomatic Diseases
Mortality
Carotid Endarterectomy
Medicaid
Drug Industry
Advisory Committees
Medicare
Nervous System Diseases
Stents
Atherosclerosis
Industry
Myocardial Infarction
Food

Keywords

  • asymptomatic
  • carotid
  • registry
  • stenosis
  • stenting
  • symptomatic

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Quality Assurance for Carotid Stenting in the CREST-2 Registry. / Lal, Brajesh K.; Roubin, Gary S.; Rosenfield, Kenneth; Heck, Donald; Jones, Michael; Jankowitz, Brian; Jovin, Tudor; Chaturvedi, Seemant; Dabus, Guilherme; White, Christopher J.; Gray, William; Matsumura, Jon; Katzen, Barry T.; Hopkins, L. Nelson; Mayorga-Carlin, Minerva; Sorkin, John D.; Howard, George; Meschia, James F.; Brott, Thomas G.

In: Journal of the American College of Cardiology, Vol. 74, No. 25, 24.12.2019, p. 3071-3079.

Research output: Contribution to journalArticle

Lal, BK, Roubin, GS, Rosenfield, K, Heck, D, Jones, M, Jankowitz, B, Jovin, T, Chaturvedi, S, Dabus, G, White, CJ, Gray, W, Matsumura, J, Katzen, BT, Hopkins, LN, Mayorga-Carlin, M, Sorkin, JD, Howard, G, Meschia, JF & Brott, TG 2019, 'Quality Assurance for Carotid Stenting in the CREST-2 Registry', Journal of the American College of Cardiology, vol. 74, no. 25, pp. 3071-3079. https://doi.org/10.1016/j.jacc.2019.10.032
Lal BK, Roubin GS, Rosenfield K, Heck D, Jones M, Jankowitz B et al. Quality Assurance for Carotid Stenting in the CREST-2 Registry. Journal of the American College of Cardiology. 2019 Dec 24;74(25):3071-3079. https://doi.org/10.1016/j.jacc.2019.10.032
Lal, Brajesh K. ; Roubin, Gary S. ; Rosenfield, Kenneth ; Heck, Donald ; Jones, Michael ; Jankowitz, Brian ; Jovin, Tudor ; Chaturvedi, Seemant ; Dabus, Guilherme ; White, Christopher J. ; Gray, William ; Matsumura, Jon ; Katzen, Barry T. ; Hopkins, L. Nelson ; Mayorga-Carlin, Minerva ; Sorkin, John D. ; Howard, George ; Meschia, James F. ; Brott, Thomas G. / Quality Assurance for Carotid Stenting in the CREST-2 Registry. In: Journal of the American College of Cardiology. 2019 ; Vol. 74, No. 25. pp. 3071-3079.
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AU - Lal, Brajesh K.

AU - Roubin, Gary S.

AU - Rosenfield, Kenneth

AU - Heck, Donald

AU - Jones, Michael

AU - Jankowitz, Brian

AU - Jovin, Tudor

AU - Chaturvedi, Seemant

AU - Dabus, Guilherme

AU - White, Christopher J.

AU - Gray, William

AU - Matsumura, Jon

AU - Katzen, Barry T.

AU - Hopkins, L. Nelson

AU - Mayorga-Carlin, Minerva

AU - Sorkin, John D.

AU - Howard, George

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