Feature | May 13, 2013

CREST Sub-Study Finds Angioplasty After Carotid Stenting Reduces Risk of Repeat Blockage

Minor adjustments during carotid artery interventions can reduce long-term restenosis at two-year follow-up and may lower risk of stroke complications

May 13, 2013 — For patients who received stents to restore blood flow through the main arteries supplying blood to the brain, inflating a tiny balloon inside the arteries after implantation of the stent reduced restenosis, or repeat blockages, of the treated arteries, making them less likely to reclose. Modifying the order in which carotid stenting and balloon angioplasty is performed could also alter risk of stroke complications, according to the investigators of the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) sub-study presented at the Society for Cardiovascular Angiography and Interventions (SCAI) 2013 Scientific Sessions. 

CREST is the largest, prospective randomized study that compared angioplasty and stenting of the carotid artery in the neck to surgery (carotid endarderectomy), the standard treatment. Carotid stenting is currently only available as a treatment option for patients who cannot undergo surgery. The objective of this sub-study was to evaluate whether undergoing angioplasty post-carotid stenting increases the risk of complications such as stroke.

“Carotid stenting is the subject of ongoing research because it provides a less invasive treatment option, which is often necessary for patients who are too sick to undergo surgery,” said Mahmoud B. Malas, M.D., lead author of the sub-study and associate professor of surgery at Johns Hopkins University and chief of endovascular surgery at Johns Hopkins Bayview Medical Center in Baltimore. “These results show performing balloon angioplasty after stenting significantly reduced the risk of those same arteries narrowing again, but may also increase, though not significantly, the risk of stroke.”

Of 1,109 patients in CREST who underwent carotid artery stenting, 69 patients underwent balloon deployment before the stent was implanted, 344 underwent balloon deployment after the stent was implanted and 696 patients had balloon angioplasty before and after the stent was implanted.

Researchers found the risk of restenosis was reduced by 64 percent simply by expanding a tiny balloon after the stent was placed in the diseased artery rather than before it was implanted. However, the group that underwent angioplasty after the stent had a larger number of strokes compared to the group who received angioplasty only prior to the stent, but that number was not statistically significant.

Results of the CREST trial also showed historically the lowest incidence of stroke as a complication of stenting and balloon angioplasty, regardless of the order. “We actually had too few complications to make any statistically significant assessment about risk of stroke between the different ballooning methods,” explained Malas.

An estimated 83.6 million adults in the United States, about one in three, currently have some form of cardiovascular disease. An estimated 6.8 Americans are expected to suffer from stroke this year alone, according to 2013 statistics from the American Heart Association.

Balloon angioplasty is a common treatment for atherosclerosis, a hardening or narrowing of major arteries throughout the body. The carotid arteries are the main arteries supplying oxygen- and nutrient-rich blood to the brain directly from the aorta as it ascends from the heart. If these essential arteries become blocked, or stenotic, there is a higher risk of stroke because of small debris breaking off from the diseased artery and traveling to the brain. Angioplasty and stenting is performed by interventional cardiologists and vascular surgeons and involves guiding tiny instruments with medical imaging through a small incision in the groin area through major blood vessels to the affected artery—in this case the carotid arteries in the neck. Once in position, a small mesh coil called a stent is implanted inside the artery.

Malas reports no relevant conflicts of interest.

For more information: www.scai.org

Related Content

radiation dose in the cath lab
News | Radiation Dose Management| May 02, 2016
May 2, 2016 — Starting at the Society for Cardiovascular Angiography and Interventions (SCAI) 2016 annual meeting May
microtubules, heartbeat mechanics, Perelman School of Medicine study

Microtubules in a cardiomyocyte at rest (top) and when compressed. Image courtesy of the lab of Ben Prosser, Ph.D., Perelman School of Medicine, University of Pennsylvania

News | EP Lab| April 29, 2016
Using new high-resolution microscopy, researchers have found that molecular struts called microtubules (MT) interact...
breast cancer, herceptin chemotherapy drug, heart damage, monitoring, Journal of Clinical Oncology study
News | Cardiac Diagnostics| April 28, 2016
April 28, 2016 — Breast cancer patients undergoing treatment with trastuzumab-containing regimens should be monitored
Feature | Business| April 28, 2016 | Dave Fornell
 
Technology | Stents Peripheral| April 27, 2016
Veniti Inc. announced the first successful treatment with the Vici Verto Venous Stent System of a patient suffering...
coronary CT angiography, CCTA, SCOT-HEART trial substudy, SCCT
News | Computed Tomography (CT)| April 26, 2016
The results of a secondary analysis of the SCOT-HEART trial show that coronary computed tomography angiography (CCTA)...
sleep patterns, metabolic syndrome, risk factors, ACC study
News | Cardiac Diagnostics| April 26, 2016
Taking long naps or being excessively tired during the day is associated with a higher risk for developing metabolic...
Auris Surgical Robotics, acquisition, Hansen Medical
News | Robotic Systems| April 26, 2016
Auris Surgical Robotics Inc. and Hansen Medical Inc. announced that they have signed a definitive merger agreement...
CABG, bypass surgery, heart failure, NHLBI study
News | Cardiovascular Surgery| April 25, 2016
Scientists have found that a greater number of patients with coronary artery disease may benefit from coronary artery...
Siemens Sensis Vibe, hemodyanamics system

Siemens released the Sensis Vibe hemodyanamics system at ACC.16. The newer system offers better integration of cath lab data into cath lab reports and the electronic medical record (EMR).

Feature | ACC| April 25, 2016 | Jon Brubaker, MBA, RCVT, Tom Watson, BS, RCVT, and Sabrina Newell MS, RCS
There were several trends seen in new cardiovascular technologies showcased on the expo floor at the 2016 American...
Overlay Init