CREST Substudy Finds Balloon Angioplasty After Carotid Stenting Reduces Restenosis Risk

May 9, 2013—The Society for Cardiovascular Angiography and Interventions (SCAI) announced the presentation of a CREST (Carotid Revascularization Endarterectomy versus Stenting Trial) substudy at the SCAI 2013 scientific sessions in Orlando, Florida. The objective of this substudy was to evaluate whether undergoing angioplasty after carotid stenting increases the risk of complications such as stroke.

Mahmoud B. Malas, MD, served as the substudy's lead investigator. Dr. Malas is associate professor of surgery at Johns Hopkins University and Chief of Endovascular Surgery at Johns Hopkins Bayview Medical Center in Baltimore, Maryland.

“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,” commented Dr. Malas in the SCAI announcement. “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.”

As summarized in the SCAI press release, of the 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 underwent balloon angioplasty before and after the stent was implanted.

The investigators found the risk of restenosis was reduced by 64% by performing balloon angioplasty after the stent was placed in the diseased artery rather than before it was implanted. The group that underwent angioplasty after the stent had a larger number of strokes compared to the group who received angioplasty only before stent placement, 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 order. “We actually had too few complications to make any statistically significant assessment about risk of stroke between the different ballooning methods,” explained Dr. Malas in the SCAI announcement.