St. John’s Mercy is currently participating in CREST: the Carotid Revascularization Endarterectomy vs. Stenting Trial. In the trial, two sets of patients — those experiencing stroke symptoms and those at high risk — are undergoing surgery to determine if stenting can be more widely used to improve outcomes.

Is Stenting Viable?

Stenting involves placing a thin, flexible tube through a small puncture in the groin. While the Federal Drug Administration (FDA) has approved its use to treat stroke in limited circumstances, CREST is underway in 140 locations nationwide to see if stenting should be indicated more broadly to avoid stroke. A previous clinical trial, the ACAS (Asymptomatic Carotid Artery Surgery) study, demonstrated a significant improvement in stroke prevention in patients undergoing surgery to correct blockages.

Richard Pennell, M.D., FACS, a vascular surgeon and chief of the Division of Vascular Surgery  at St. John’s Mercy (as well as medical director of the Blood Flow Laboratory) is hopeful the trial will further prove stents are a sound way to avoid the sudden death or longterm disability stroke can inflict.

“Carotid endarterectomy, the current care standard, works,” notes Dr. Pennell. “But it involves a neck incision to correct the carotid artery blockage that causes stroke and carries a potential side effect of nerve damage in the neck and visible scarring. Stenting does not, and it involves less patient discomfort overall. If it’s shown safe and effective, it could represent a great leap forward in prevention.”

In addition to Dr. Pennell, other surgeons participating in the trial include Vito Mantese, M.D., and Scott Westfall, M.D.

Stroke Risk Factors

Awareness also is important in reducing stroke deaths. “The single biggest thing a person can do to decrease risk is not smoke,” says Dr. Pennell. “Don’t ever start, or if you smoke, quit now.”

Arterial plaques that contribute to stroke risk occur naturally with age, which is why stroke occurs most often in older persons. But among smokers, Dr. Pennell has performed corrective surgery for patients as young as the mid-30s.

Besides not smoking, other actions you can take to reduce risk include:

• Eating a relatively low fat diet
• Keeping cholesterol in check
• Controlling high blood pressure, if you have it
• Exercising regularly.

Participating in the Trial

St. John’s Mercy is currently seeking participants for CREST. Eligible persons will have either a 50 percent stenosis (narrowing) of the carotid artery with symptoms, or greater than 70 percent blockage without symptoms.

Participants will have access to a therapy not yet available to the general public, and they will be treated in St. John’s Mercy’s new Heart Hospital in one of three expanded, state-of-the-art imaging suites. The cost of the procedure is usually covered by insurance. Additional expenses may be covered by the study.

For more information, contact the St. Louis Vascular Center at St. John’s Mercy at 314-251-4200.