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Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial - Hemodynamics (CREST-H)

About

Brief Summary

We aim to determine whether cognitive impairment attributable to cerebral hemodynamic impairment in patients with high-grade asymptomatic carotid artery stenosis is reversible with restoration of flow. To accomplish this aim CREST-H will add on to the NINDS-sponsored CREST-2 trial (parallel, outcome-blinded Phase 3 clinical trials for patients with asymptomatic high-grade carotid artery stenosis which will compare carotid endarterectomy plus intensive medical management (IMM) versus IMM alone (n=1,240), and carotid artery stenting plus IMM versus IMM alone (n=1,240) to prevent stroke and death).

CREST-H addresses the intriguing question of whether cognitive impairment can be reversed when it arises from abnormal cerebral hemodynamic perfusion in a hemodynamically impaired subset of the CREST-2 -randomized patients. We will enroll 350 patients from CREST-2, all of whom receive cognitive assessments at baseline and yearly thereafter. We anticipate identifying 100 patients with hemodynamic impairment as measured by an inter-hemispheral MRI perfusion "time to peak" (TTP) delay on the side of stenosis. Among those who are found to be hemodynamically impaired and have baseline cognitive impairment, the cognitive batteries at baseline and at 1 year will determine if those with flow failure who are randomized to a revascularization arm in CREST-2 will have better cognitive outcomes than those in the medical-only arm compared with this treatment difference for those who have no flow failure. We hypothesize that hemodynamically significant "asymptomatic" carotid disease may represent one of the few examples of treatable causes of cognitive impairment. If cognitive decline can be reversed in these patients, then we will have established a new indication for carotid revascularization independent of the risk of recurrent stroke.

Study Type
Observational
Phase
N/A

Eligibility

Gender
All
Healthy Volunteers
No
Minimum Age
35 Years
Maximum Age
86 Years

Inclusion Criteria:

  • Enrolled and randomized into CREST-2 (parent study)
  • Inclusion criteria for CREST-2
  • age 35-86

Exclusion Criteria (in addition to the exclusion criteria for CREST-2):

  • unable to undergo MRI (e.g. metal in body, pacemaker)
  • known allergy gadolinium contrast dye
  • pre-existing diagnosis of dementia
  • contralateral ICA stenosis >70% by MRA, CTA or Doppler ultrasound
  • history of severe head trauma
  • major depression
  • education less than 8 years

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Study Stats
Protocol No.
18-000747
Category
Surgery
Contact
Nakeisha Favors
Location
  • UCLA Westwood
For Providers
NCT No.
NCT03121209
For detailed technical eligibility, visit ClinicalTrials.gov.