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

The first 3-D images have been created of an RNA molecule known as "Braveheart" for its role in transforming stem cells into heart cells. Credit: Image courtesy Los Alamos National Laboratory

The first 3-D images have been created of an RNA molecule known as "Braveheart" for its role in transforming stem cells into heart cells. Credit: Image courtesy Los Alamos National Laboratory

News | Cardiovascular Clinical Studies | January 20, 2020
January 20, 2020 — Scientists at Los Alamos and international partners have created the first 3-D images of a special
Top Cardiology New in 2019 From the European Society of Cardioloigy (ESC)
News | Cardiovascular Clinical Studies | December 23, 2019
Environmental and lifestyle issues were popular this year, with pick up from both...
News | Cardiovascular Clinical Studies | November 26, 2019
November 26, 2019 — The University of Connecticut (UConn) Department of Kinesiology and Hartford Healthcare have sele
FDA Issues Final Guidance on Live Case Presentations During IDE Clinical Trials
News | Cardiovascular Clinical Studies | July 10, 2019
The U.S. Food and Drug Administration (FDA) issued the final guidance “Live Case Presentations During Investigational...
Veradigm Partners With American College of Cardiology on Next-generation Research Registries
News | Cardiovascular Clinical Studies | July 03, 2019
The American College of Cardiology (ACC) has partnered with Veradigm, an Allscripts business unit, to power the next...
New FDA Proposed Rule Alters Informed Consent for Clinical Studies
News | Cardiovascular Clinical Studies | November 19, 2018
The U.S. Food and Drug Administration (FDA) is proposing to add an exception to informed consent requirements for...
A key slide from Elnabawi's presentation, showing cardiac CT plaque evaluations, showing the impact of psoriasis medication on coronary plaques at baseline and one year of treatment. It shows a reversal of vulnerable plaque development. #SCAI, #SCAI2018

A key slide from Elnabawi's presentation, showing cardiac CT plaque evaluations, showing the impact of psoriasis medication on coronary plaques at baseline and one year of treatment. It shows a reversal of vulnerable plaque development.  

Feature | Cardiovascular Clinical Studies | May 14, 2018
May 14, 2018 – New clinical evidance shows common therapy options for psoriasis (PSO), a chronic inflammatory skin di
Intravenous Drug Use is Causing Rise in Heart Valve Infections, Healthcare Costs. #SCAI, #SCAI2018
News | Cardiovascular Clinical Studies | May 14, 2018
May 14, 2018 — The opioid drug epidemic is impacting cardiology, with a new study finding the number of patients hosp
Patient Enrollment Completed in U.S. IDE Study of THERMOCOOL SMARTTOUCH SF Catheter
News | Cardiovascular Clinical Studies | March 15, 2018
March 15, 2018 –  Johnson & Johnson Medical Devices Companies announced today that Biosense Webster, Inc., who wo