Brajesh K Lal1, Gary S Roubin2, Kenneth Rosenfield3, Donald Heck4, Michael Jones5, Brian Jankowitz6, Tudor Jovin7, Seemant Chaturvedi8, Guilherme Dabus9, Christopher J White10, William Gray11, Jon Matsumura12, Barry T Katzen13, L Nelson Hopkins14, Minerva Mayorga-Carlin15, John D Sorkin16, George Howard17, James F Meschia18, Thomas G Brott18. 1. Department of Vascular Surgery, University of Maryland, Baltimore, Maryland. Electronic address: blal@som.umaryland.edu. 2. Department of Cardiology, Cardiovascular Associates of the Southeast/Brookwood Baptist Medical Center, Birmingham, Alabama. 3. Department of Cardiology, Massachusetts General Hospital, Boston, Massachusetts. 4. Department of Radiology, Novant Health Clinical Research, Winston-Salem, North Carolina. 5. Department of Cardiology, Baptist Health Lexington, Lexington, Kentucky. 6. Department of Neurosurgery, UPMC Presbyterian University Hospital, Pittsburgh, Pennsylvania. 7. Department of Neurology, UPMC Presbyterian University Hospital, Pittsburgh, Pennsylvania. 8. Department of Neurology, University of Maryland, Baltimore, Maryland. 9. Department of Interventional Neuroradiology, Miami Cardiac and Vascular Institute at Baptist Hospital of Miami, Miami, Florida. 10. Department of Cardiology, Ochsner Health System, New Orleans, Louisiana. 11. Department of Cardiology, Lankenau Medical Center, Wynnewood, Pennsylvania. 12. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. 13. Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Florida. 14. Department of Neurosurgery, SUNY Buffalo, Buffalo, New York. 15. Department of Vascular Surgery, University of Maryland, Baltimore, Maryland. 16. Department of Biostatistics and Informatics, Baltimore VA Medical Center, Baltimore, Maryland. 17. Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama. 18. Department of Neurology, Mayo Clinic, Jacksonville, Florida.
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.
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.
Authors: Young Erben; James F Meschia; Donald V Heck; Fayaz A Shawl; Minerva Mayorga-Carlin; George Howard; Kenneth Rosenfield; John D Sorkin; Thomas G Brott; Brajesh K Lal Journal: Catheter Cardiovasc Interv Date: 2021-08-13 Impact factor: 2.585
Authors: Darko Quispe-Orozco; Kaustubh Limaye; Cynthia B Zevallos; Mudassir Farooqui; Alan Mendez-Ruiz; Sameer Ansari; Andres Dajles; Edgar A Samaniego; Colin Derdeyn; Santiago Ortega-Gutierrez Journal: Interv Neuroradiol Date: 2020-12-06 Impact factor: 1.764
Authors: Jon S Matsumura; Bret M Hanlon; Kenneth Rosenfield; Jenifer H Voeks; George Howard; Gary S Roubin; Thomas G Brott Journal: J Vasc Surg Date: 2021-10-22 Impact factor: 4.860