Quality Assurance for Carotid Stenting in the CREST-2 Registry

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:74

Article

Lal, Brajesh K.¹  Roubin, Gary S.²  Rosenfield, Kenneth³  Heck, Donald⁴  Jones, Michael⁵  Jankowitz, Brian⁶  Jovin, Tudor⁷  Chaturvedi, Seemant⁸  Dabus, Guilherme⁹  White, Christopher J.¹⁰  Gray, William¹¹  Matsumura, Jon¹²  Katzen, Barry T.¹³  Hopkins, L. Nelson¹⁴  Mayorga-Carlin, Minerva¹  Sorkin, John D.¹⁵  Howard, George¹⁶  Meschia, James F.¹⁷  Brott, Thomas G.¹⁷ 

[1] Univ Maryland, Dept Vasc Surg, Baltimore, MD 21201 USA

[2] Brookwood Baptist Med Ctr, Dept Cardiol, Cardiovasc Associates Southeast, Birmingham, AL USA

[3] Massachusetts Gen Hosp, Dept Cardiol, Boston, MA 02114 USA

[4] Novant Hlth Clin Res, Dept Radiol, Winston Salem, NC USA

[5] Baptist Hlth Lexington, Dept Cardiol, Lexington, KY USA

[6] UPMC Presbyterian Univ Hosp, Dept Neurosurg, Pittsburgh, PA USA

[7] UPMC Presbyterian Univ Hosp, Dept Neurol, Pittsburgh, PA USA

[8] Univ Maryland, Dept Neurol, Baltimore, MD 21201 USA

[9] Baptist Hosp Miami, Dept Intervent Neuroradiol, Miami Cardiac & Vasc Inst, Miami, FL USA

[10] Ochsner Hlth Syst, Dept Cardiol, New Orleans, LA USA

[11] Lankenau Med Ctr, Dept Cardiol, Wynnewood, PA USA

[12] Univ Wisconsin, Dept Surg, Sch Med & Publ Hlth, Madison, WI USA

[13] Miami Cardiac & Vasc Inst, Dept Intervent Radiol, Miami, FL USA

[14] SUNY Buffalo, Dept Neurosurg, Buffalo, NY USA

[15] Baltimore VA Med Ctr, Dept Biostat & Informat, Baltimore, MD USA

[16] Univ Alabama Birmingham, Dept Biostat, Birmingham, AL 35294 USA

[17] Mayo Clin, Dept Neurol, Jacksonville, FL 32224 USA

关键词: asymptomatic;    carotid;    registry;    stenosis;    stenting;    symptomatic;   

DOI  :  10.1016/j.jacc.2019.10.032

来源: Elsevier

【 摘 要 】

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. (C) 2019 by the American College of Cardiology Foundation.

【 授权许可】

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