Landmark NIH clinical trial comparing two stroke prevention procedures shows surgery and stenting equally safe and effective

Mayfield neurosurgeons played contributing role in research

CINCINNATI–A major new study of people at risk of stroke showed that two medical procedures designed to prevent future strokes are safe and effective overall.

In a joint announcement at the International Stroke Conference in San Antonio, the National Institute of Neurological Disorders and Stroke and the Mayo Clinic reported today that physicians will now have more options in tailoring treatments for their patients at risk for stroke.

Researchers from 117 centers in the United States and Canada, including the Mayfield Clinic, compared carotid endarterectomy (CEA), a surgical procedure that clears blocked blood flow and is considered the gold standard in preventative treatment, to carotid artery stenting (CAS), a newer and less invasive procedure that involves threading a stent and expanding a small protective device in the artery to widen the blocked area and capture any dislodged plaque.

One of the largest randomized stroke prevention trials ever, the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST) involved 2,502 participants over a nine-year period.

CREST compared the safety and effectiveness of CEA and CAS in patients with or without a previous history of stroke. The trial was funded by NINDS, which is part of the National Institutes of Health, and was led by investigators at Mayo Clinic, Jacksonville, Fla., and the University of Medicine and Dentistry of New Jersey in Newark.

Cincinnati’s portion of the trial was led by Mayfield’s Mario Zuccarello, MD, Professor and Interim Chair of the Department of Neurosurgery at the University of Cincinnati and Director of Cerebrovascular Surgery, and Andrew Ringer, MD, Associate Professor and Director of Endovascular Neurosurgery at UC. Drs. Zuccarello and Ringer are members of the UC Neuroscience Institute.

Related: Andrew Ringer, MD explains the results of CREST, the Carotid Revascularization Endarterectomy vs Stenting Trial for patients suffering from carotid atherosclerosis

Read the complete news release from NINDS >>

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The Mayfield Clinic is recognized as one of the nation's leading physician organizations for clinical care, education, and research of the spine and brain. Supported by 20 neurosurgeons, five neurointensivists, an interventional radiologist, and a pain specialist, the Clinic treats 25,000 patients from 35 states and 13 countries in a typical year. Mayfield's physicians have pioneered surgical procedures and instrumentation that have revolutionized the medical art of neurosurgery for brain tumors and neurovascular diseases and disorders.

In carotid stenosis, atherosclerotic plaque narrows the artery diameter, reducing blood flow (fig. A ).

The irregular surface of the artery wall can cause clot formation that blocks the vessel or breaks off, travels downstream, and blocks a smaller vessel (fig. B).