The CREST-2 Registry (C2R)

  • End date
    Jan 21, 2025
  • participants needed
  • sponsor
    University of Maryland, Baltimore
Updated on 21 July 2022
amaurosis fugax
ischemic attack
neurologic symptoms


The objective of C2R is to promote the rapid initiation and completion of enrollment in the CREST-2 randomized clinical trial ( ID NCT02089217). Patients with severe symptomatic and asymptomatic carotid artery occlusive disease will be treated with carotid artery stenting (CAS) performed by experienced and skilled interventionists. Interventionists' eligibility will be determined by a multi-specialty Interventional Management Committee (IMC). Patient eligibility will include patients with standard or high-risk, symptomatic or asymptomatic carotid artery disease. Patients will be followed for the occurrence of post-procedural complications. The primary safety and quality endpoint will be the occurrence of any stroke or death within the 30-day period following the stenting procedure. The safety and quality results from C2R will guide selection of interventionists for participation in the CREST-2 randomized clinical trial. Enrollment into C2R will begin in 2015 and continue until publication of the primary results of the randomized trial.


  1. Promote the rapid initiation and completion of enrollment in CREST-2
  2. CAS will be performed by experienced operators
  3. Clinical outcomes will be closely monitored
  4. Prevent inappropriate use of CAS outside of the registry

Registry Data Collection:

The registry will leverage the existing data-collection infrastructure of the Society for Vascular Surgery's (SVS) Vascular Quality Initiative (VQI) and the American College of Cardiology's (ACC) National Cardiovascular Data Registry (NCDR). Both organizations have agreed to participate in this effort. The specific logistics of data-collection and transfer

  • The interventionist must pick a registry, SVS VQI or ACC NCDR to enter data.
  • The interventionist instructs their registry to transfer de-identified information about their cases to C2R.
  • The cases are reviewed by the C2R Management Committee.
  • Reports of the cases, including whether or not they are CREST-2 eligible, will be maintained. These reports will allow close monitoring of C2R interventionists.
  • C2R Management Committee, and other parties (NINDS, CMS) will be informed of the progress periodically.

The registry will collect information on key co-morbidities and limit the outcome measures to essential, easily used standardized measures that are commonly part of carotid trials, including the NIH Stroke Scale and the Modified Rankin Scale (mRS). The 30-day visit will be conducted face-to-face with a history, examination and testing.

  • DEMOGRAPHICS AND MEDICAL HISTORY: Gender, symptomatic status, carotid artery to be treated, hypertension, diabetes, coronary artery disease, congestive heart failure, and renal failure.
  • MONITORING ENROLLMENT: The Registry will also collect information on features that represent inclusion/exclusion criteria for the CREST-2 randomized trial. The purpose is to facilitate monitoring of the type of patients being enrolled in C2R, and ensuring that CREST-2-eligible patients are not being enrolled excessively into C2R in preference to CREST-2. Data- collection, transfer and review will occur rapidly enough that sites not complying with enrollment limitations will be identified rapidly and appropriate action taken.
  • PROCEDURAL DETAILS: The C2R focuses on procedural details that will facilitate an assessment for credentialing interventionists into the CREST-2 trial. The interventional management committee will review this data to make decisions regarding whether or not to approve a particular operator for randomizing patients into the trial. Some of the factors to be considered will include:
  • Total number of cases performed per year, total number of cases performed in career
  • Selection of devices, case selection, stroke rate, hemorrhagic complications.
  • Techniques for access, sheath placement, wire access, embolic protection, angioplasty, stent deployment, use of post-stent angioplasty, selection of closure devices, use of medications (antiplatelets, anticoagulation, atropine, nitroglycerine).
  • PATIENT ASSESSMENT AND OUTCOMES: NIH Stroke Scale, modified Rankin Score, access site hemorrhage, recurrent hospitalization or need for second carotid procedure, new onset of renal failure, stroke, and death.

Eligibility to participate in the C2R


  • Any center currently certified by CMS to provide CAS will be eligible to apply for participation in the C2R.


  • Individual operators must have done at least 50 total procedures to be eligible for the registry. If they have done less than 50 procedures, then they must have done at least 8 procedures over the last 2 years.
  • Individual operators must have been reviewed and approved by the interventional management committee.
  • The final decision regarding eligibility will also depend on an assessment of technique, outcomes and anticipated carotid disease volume at a particular site.

Procedures to ensure enrollment into the randomized trial

  • The maximal enrollment number for C2R for a given site prior to randomization into CREST-2 will be a total of 75 cases or 30 CREST-2 eligible patients, whichever comes first.
  • Operators that have been credentialed by the IMC to enroll patients in CREST-2 must begin to enroll eligible patients in the trial, while other operators at the same site continue to work toward credentialed status.
  • Sites that have reached the maximum thresholds above and are not initiated as CREST-2 sites will have registry status denied at the discretion of the C2R Management committee depending on bona fide, good faith efforts to meet CREST-2 site initiation requirements.
  • The C2R will track whether or not each patient enrolled in the registry was CREST-2 eligible. Once any operator at a site has been approved to enroll patients in CREST-2, the site will be expected to offer enrollment into CREST- 2 to every CREST-2 eligible patient. It is anticipated that not all such CREST-2 eligible patients will consent to randomization into CREST-2; such patients, can be enrolled into the registry. However, only 1 CREST-2-eligible patient can be enrolled into C2R for each patient enrolled into CREST-2, i.e. in a 1:1 ratio.
  • Sites that do not maintain the 1:1 ratio of patients enrolled in CREST-2 to trial-eligible patients enrolled in C2R will be notified by the C2R Management Committee that they are on a probationary status to remedy the situation. If not remedied, they will be notified that their C2R status is being revoked.
  • Sites that are not enrolling into CREST-2 at a reasonable rate (to be determined by the C2R Management Committee and the CREST-2 Executive Committee) will have their eligibility to enroll in the C2R suspended until they are adequately enrolling in the trial.
  • Once the CAS arm of CREST-2 is fully enrolled, continued enrollment of eligible patients (see inclusion/exclusion criteria above) in the C2R will be allowed.
  • The DSMB will review CREST-2 trial results at the end of enrollment of the CREST-2 trial to decide at that time if it is ethical to continue C2R.

Registry Oversight / Governance

The C2R will be operated under a multi-specialty Steering Committee. The Steering Committee will include members from relevant disciplines. Representatives from the CREST-2, NINDS, and CMS will be members of the Steering Committee. The Steering Committee shall provide strategic direction to C2R, monitor all activities, and have ultimate authority and responsibility for the scientific integrity and appropriate use of the C2R data for research and publications. Operational responsibilities of the Steering Committee will include oversight of the CAS operator/facility credentialing process as well as developing and improving other key aspects of registry functions.

The Steering Committee will also have the discretion to modify elements of this protocol if such changes are determined to be necessary for the successful implementation of C2R.

The Management Committee will carry out day-to-day management and regulatory responsibilities, reporting to the Steering Committee. Membership will include at least one leader from the surgical, stenting, and neurological communities. The registry Principal Investigator (PI) will be Brajesh K. Lal, Co-Principal Investigator of CREST-2.

Condition Carotid Artery Diseases
Treatment Carotid Artery Stent
Clinical Study IdentifierNCT02240862
SponsorUniversity of Maryland, Baltimore
Last Modified on21 July 2022


How to participate?

Step 1 Connect with a study center
What happens next?
  • You can expect the study team to contact you via email or phone in the next few days.
  • Sign up as volunteer to help accelerate the development of new treatments and to get notified about similar trials.

You are contacting

Investigator Avatar

Primary Contact



Additional screening procedures may be conducted by the study team before you can be confirmed eligible to participate.

Learn more

If you are confirmed eligible after full screening, you will be required to understand and sign the informed consent if you decide to enroll in the study. Once enrolled you may be asked to make scheduled visits over a period of time.

Learn more

Complete your scheduled study participation activities and then you are done. You may receive summary of study results if provided by the sponsor.

Learn more

Similar trials to consider


Browse trials for

Not finding what you're looking for?

Every year hundreds of thousands of volunteers step forward to participate in research. Sign up as a volunteer and receive email notifications when clinical trials are posted in the medical category of interest to you.

Sign up as volunteer

user name

Added by • 



Reply by • Private

Lorem ipsum dolor sit amet consectetur, adipisicing elit. Ipsa vel nobis alias. Quae eveniet velit voluptate quo doloribus maxime et dicta in sequi, corporis quod. Ea, dolor eius? Dolore, vel!

  The passcode will expire in None.

No annotations made yet

Add a private note
  • abc Select a piece of text from the left.
  • Add notes visible only to you.
  • Send it to people through a passcode protected link.
Add a private note