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CREST Stroke Study Shows that Preventive Procedures are Safe and Effective
By Nancy Kennedy

Most American who are in their midlife or senior years worry about getting cancer or having a heart attack. But we need to be equally concerned with the risk of stroke, which is the third leading cause of death in the U.S., and the number one cause of permanent, life-altering disability among adults. About 700,000 strokes occur in the U.S. each year, with 4 out of every 5 families somewhat affected. 75% of strokes affect people over the age of 65 and the risk of having a stroke more than doubles with every decade after age 55. Someone in the U.S. dies every three minutes from having a stroke.

Statistics such as these are alarming to Richard Begg, M.D., F.A.C.C., an interventional cardiologist at Heritage Valley Health System's Heart and Vascular Center. Begg is passionate about helping to prevent future strokes in those who are at risk and raising public awareness regarding stroke. "A stroke can be fatal or can cause devastating disabilities such as blindness, paralysis or loss of speech," Begg explains. "Screening tools exist, but as yet there are no widespread screening programs approved, like mammography screening for breast cancer prevention. Surviving a stroke – and surviving one with the brain and nervous system intact – is possible, but depends on recognition of the symptoms, immediate diagnosis and prompt intervention, using the most advanced technology and procedures, within a narrow window of time. A delay or mistake can have grave consequences: every passing moment may mean the loss of brain tissue.

"Unfortunately, there are obstacles to the timely treatment of a stroke in progress. The symptoms can be vague, and few people can readily identify the symptoms of stroke. Furthermore, those advanced technologies for treating stroke are not available in every hospital. Sadly, once a stroke is happening, the odds are against you. Prevention is therefore the key."

Strokes happen in two ways: either as a result of a clot that blocks the carotid artery, depriving brain tissue of oxygen, or as the result of hemorrhage from an aneurysm, a weakened blood vessel that leaks or ruptures.

Begg served as a principal investigator in a major multi-center trial that validated the safety and effectiveness of two medical procedures to treat carotid artery disease. Known as the Carotid Revascularization and Endarterectomy vs. Stenting Trial, or CREST, it is one of the largest randomized stroke prevention trials ever conducted. The study compared carotid artery stenting (CAS) to carotid endarterectomy (CEA). It was conducted over a nine year period and involved 2,502 participants.

CEA is a surgical procedure that clears blocked carotid arteries by making an incision on the neck to clear blocked blood flow and is considered the gold standard prevention treatment. CEA was compared to CAS, a new, less invasive procedure that involves inserting a stent and expanding it in the carotid artery to widen the blocked area. The overall safety and efficacy of the two procedures was largely the same with equal benefits for men and women, and for patients who had or had not previously had a stroke. Heritage Valley was one of the top ten centers for enrollment in the CREST study, which was sponsored by the National Institute of Neurological Disorders and Stroke.

"The CREST trial results verified that we now have two safe and effective methods to treat carotid artery disease directly, through CEA and the less invasive method CAS," said Begg, co-investigator with Jasvinder Sandhu, M.D., F.A.C.C. "We are always seeking less invasive methods to prevent stroke. The good news is that whatever method a patient chooses, the results should be excellent."

Stroke represents a public health problem that is likely to worsen in the next decades, as the Baby Boomer generation reaches the age of 65, a time when previously latent cardiovascular disease presents its bill in the form of heart attack, stroke and other conditions. Although mortality rates for cardiovascular disease have been falling thanks to medical advances, factors such as obesity and diabetes, inadequate access to care and the aging of the population are growing challenges.

According to the Centers for Disease Control, cardiovascular disease is the leading cause of death in every state within the United States, including Pennsylvania, killing more people every day than all other causes of death combined. The chances of having a stroke or heart attack are extremely high: 1 in 3 American adults have cardiovascular disease and are at risk.

"Preventing stroke and heart attack, in fact preventing cardiovascular disease in general, is largely a matter of knowing your risk factors and knowing the symptoms. We can do better, by raising public awareness about stroke and cardiovascular disease," says Begg, "and educating people about healthy lifestyles."

Heritage Valley's carotid stent program was developed in 2000 and is one of the largest programs in Western Pennsylvania. The success of the program can be attributed to the multi-disciplinary Heart and Vascular Center team, which includes diagnostic and interventional cardiology, cardio-thoracic surgery, electrophysiology and cardiac rehab services, making the center's approach to the management of carotid artery disease unique.

For more information, visit Heritage Valley Health System on the web at www.heritagevalley.org or call (877) 771-HVHS (4847)

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