Evidence map›Paper›PMID 26351359›Full record

Trial reportStroke2015

Mediators of the Age Effect in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST).

Jenifer H Voeks, George Howard, Gary Roubin, Richard Farb, Donald Heck, William Logan, Mary Longbottom, Alice Sheffet, James F Meschia, Thomas G Brott

Registry-linked trialAbstract readComparative StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Stroke, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00004732 (Carotid Revascularization Endarterectomy Versus Stenting Trial), which is not on this map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00004732 nacompletednot on this map

Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST)

TypeinterventionalSponsorRutgers, The State University of New JerseyRan2000 to 2016Enrolled2,502ConditionsAtherosclerosis, Stroke, Carotid Stenosis, Cerebral InfarctionArmsCarotid Endarterectomy (CEA), Carotid Artery Stenting (CAS)
3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. [Prevention of ischemic stroke in old age].Zeitschrift fur Gerontologie und Geriatrie · 2024
    Review
  2. Article
  3. Article
  4. Article
  5. Article
  6. Interventions for Extracranial Carotid Artery Stenosis: An Update.Current treatment options in cardiovascular medicine · 2016
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Jenifer H VoeksFrom the Department of Neurology, Medical University of South Carolina, Charleston (J.H.V.); Department of Biostatistics, University of Alabama at Birmingham (G.H.); Cardiovascular Associates of the Southeast, Birmingham, AL (G.R.); Division of Neuroradiology, Department of Medical Imaging, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada (R.F.); Department of Radiology, Novant Health Forsyth Medical Center, Winston-Salem, NC (D.H.); Mercy Clinic Neurology, Mercy Hospital, St. Louis, MO (W.L.); Department of Neurology, Mayo Clinic, Jacksonville, FL (M.L., J.F.M., T.G.B.); and Department of Surgery, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark (A.S., T.G.B.).
George HowardFrom the Department of Neurology, Medical University of South Carolina, Charleston (J.H.V.); Department of Biostatistics, University of Alabama at Birmingham (G.H.); Cardiovascular Associates of the Southeast, Birmingham, AL (G.R.); Division of Neuroradiology, Department of Medical Imaging, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada (R.F.); Department of Radiology, Novant Health Forsyth Medical Center, Winston-Salem, NC (D.H.); Mercy Clinic Neurology, Mercy Hospital, St. Louis, MO (W.L.); Department of Neurology, Mayo Clinic, Jacksonville, FL (M.L., J.F.M., T.G.B.); and Department of Surgery, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark (A.S., T.G.B.).
Gary RoubinFrom the Department of Neurology, Medical University of South Carolina, Charleston (J.H.V.); Department of Biostatistics, University of Alabama at Birmingham (G.H.); Cardiovascular Associates of the Southeast, Birmingham, AL (G.R.); Division of Neuroradiology, Department of Medical Imaging, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada (R.F.); Department of Radiology, Novant Health Forsyth Medical Center, Winston-Salem, NC (D.H.); Mercy Clinic Neurology, Mercy Hospital, St. Louis, MO (W.L.); Department of Neurology, Mayo Clinic, Jacksonville, FL (M.L., J.F.M., T.G.B.); and Department of Surgery, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark (A.S., T.G.B.).
Richard FarbFrom the Department of Neurology, Medical University of South Carolina, Charleston (J.H.V.); Department of Biostatistics, University of Alabama at Birmingham (G.H.); Cardiovascular Associates of the Southeast, Birmingham, AL (G.R.); Division of Neuroradiology, Department of Medical Imaging, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada (R.F.); Department of Radiology, Novant Health Forsyth Medical Center, Winston-Salem, NC (D.H.); Mercy Clinic Neurology, Mercy Hospital, St. Louis, MO (W.L.); Department of Neurology, Mayo Clinic, Jacksonville, FL (M.L., J.F.M., T.G.B.); and Department of Surgery, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark (A.S., T.G.B.).
Donald HeckFrom the Department of Neurology, Medical University of South Carolina, Charleston (J.H.V.); Department of Biostatistics, University of Alabama at Birmingham (G.H.); Cardiovascular Associates of the Southeast, Birmingham, AL (G.R.); Division of Neuroradiology, Department of Medical Imaging, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada (R.F.); Department of Radiology, Novant Health Forsyth Medical Center, Winston-Salem, NC (D.H.); Mercy Clinic Neurology, Mercy Hospital, St. Louis, MO (W.L.); Department of Neurology, Mayo Clinic, Jacksonville, FL (M.L., J.F.M., T.G.B.); and Department of Surgery, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark (A.S., T.G.B.).
William LoganFrom the Department of Neurology, Medical University of South Carolina, Charleston (J.H.V.); Department of Biostatistics, University of Alabama at Birmingham (G.H.); Cardiovascular Associates of the Southeast, Birmingham, AL (G.R.); Division of Neuroradiology, Department of Medical Imaging, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada (R.F.); Department of Radiology, Novant Health Forsyth Medical Center, Winston-Salem, NC (D.H.); Mercy Clinic Neurology, Mercy Hospital, St. Louis, MO (W.L.); Department of Neurology, Mayo Clinic, Jacksonville, FL (M.L., J.F.M., T.G.B.); and Department of Surgery, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark (A.S., T.G.B.).
Mary LongbottomFrom the Department of Neurology, Medical University of South Carolina, Charleston (J.H.V.); Department of Biostatistics, University of Alabama at Birmingham (G.H.); Cardiovascular Associates of the Southeast, Birmingham, AL (G.R.); Division of Neuroradiology, Department of Medical Imaging, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada (R.F.); Department of Radiology, Novant Health Forsyth Medical Center, Winston-Salem, NC (D.H.); Mercy Clinic Neurology, Mercy Hospital, St. Louis, MO (W.L.); Department of Neurology, Mayo Clinic, Jacksonville, FL (M.L., J.F.M., T.G.B.); and Department of Surgery, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark (A.S., T.G.B.).
Alice SheffetFrom the Department of Neurology, Medical University of South Carolina, Charleston (J.H.V.); Department of Biostatistics, University of Alabama at Birmingham (G.H.); Cardiovascular Associates of the Southeast, Birmingham, AL (G.R.); Division of Neuroradiology, Department of Medical Imaging, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada (R.F.); Department of Radiology, Novant Health Forsyth Medical Center, Winston-Salem, NC (D.H.); Mercy Clinic Neurology, Mercy Hospital, St. Louis, MO (W.L.); Department of Neurology, Mayo Clinic, Jacksonville, FL (M.L., J.F.M., T.G.B.); and Department of Surgery, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark (A.S., T.G.B.).
James F MeschiaFrom the Department of Neurology, Medical University of South Carolina, Charleston (J.H.V.); Department of Biostatistics, University of Alabama at Birmingham (G.H.); Cardiovascular Associates of the Southeast, Birmingham, AL (G.R.); Division of Neuroradiology, Department of Medical Imaging, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada (R.F.); Department of Radiology, Novant Health Forsyth Medical Center, Winston-Salem, NC (D.H.); Mercy Clinic Neurology, Mercy Hospital, St. Louis, MO (W.L.); Department of Neurology, Mayo Clinic, Jacksonville, FL (M.L., J.F.M., T.G.B.); and Department of Surgery, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark (A.S., T.G.B.).
Thomas G BrottFrom the Department of Neurology, Medical University of South Carolina, Charleston (J.H.V.); Department of Biostatistics, University of Alabama at Birmingham (G.H.); Cardiovascular Associates of the Southeast, Birmingham, AL (G.R.); Division of Neuroradiology, Department of Medical Imaging, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada (R.F.); Department of Radiology, Novant Health Forsyth Medical Center, Winston-Salem, NC (D.H.); Mercy Clinic Neurology, Mercy Hospital, St. Louis, MO (W.L.); Department of Neurology, Mayo Clinic, Jacksonville, FL (M.L., J.F.M., T.G.B.); and Department of Surgery, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark (A.S., T.G.B.). Brott.Thomas@mayo.edu.

Funding

Carotid Revascularization Endarterectomy vs Stenting TrialR01NS038384 · NINDS · UNIV OF MED/DENT OF NJ-NJ MEDICAL SCHOOL · PI BROTT, THOMAS G · 1999 to 2010
$40.7M
Carotid Revascularization Endarterectomy vs. Stenting Trial: Long Term Follow-upU01NS038384 · NINDS · UNIV OF MED/DENT OF NJ-NJ MEDICAL SCHOOL · PI BROTT, THOMAS G, SHEFFET, ALICE J · 2011 to 2016
$15.4M
NINDS NIH HHS R01 NS038384NINDS NIH HHS U01 NS 038384NINDS NIH HHS U01 NS038384
6 · The paper itself

Abstract

background and purposeThere is higher combined risk of stroke or death (S+D) at older ages with carotid stenting. We assess whether this can be attributed to patient or arterial characteristics that are in the pathway between older age and higher risk.

methodsMediation analysis of selected patient (hypertension, diabetes mellitus, and dyslipidemia) and arterial characteristics assessed at the clinical sites and the core laboratory (plaque length, eccentric plaque, ulcerated plaque, percent stenosis, peak systolic velocity, and location) was performed in 1123 carotid artery stenting-treated patients in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST). We assessed the association of age with these characteristics, the association of these characteristics with stroke risk, and the amount of mediation of the association of age on the combined risk of periprocedural S+D with adjustment for these factors.

resultsOnly plaque length as measured at the sites increased with age, was associated with increased S+D risk and significantly mediated the association of age on S+D risk. However, adjustment for plaque length attenuated the increased risk per 10 years of age from 1.72 (95% confidence interval, 1.26-2.37) to 1.66 (95% confidence interval, 1.20-2.29), accounting for only 8% of the increased risk.

conclusionsPlaque length seems to be in the pathway between older age and higher risk of S+D among carotid artery stenting-treated patients, but it mediated only 8% of the age effect excess risk of carotid artery stenting in CREST. Other factors and mechanisms underlying the age effect need to be identified as plaque length will not identify elderly patients for whom stenting is safe relative to endarterectomy. CLINICAL

trial registrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT00004732.

Indexed as

StentsAgedAged, 80 and overAge FactorsCarotid Artery DiseasesCarotid StenosisCerebral AngiographyEndarterectomy, CarotidEndovascular ProceduresFemaleHumansMaleMiddle AgedPlaque, AtheroscleroticPostoperative ComplicationsRisk Factorsagecarotid arteriesrisk factorsstentsstroke

Identifiers

PMID26351359
PMCPMC4617689

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.