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Vascular Imaging Core
DepartmentsDepartment of SurgeryDivisionsDivision of Vascular SurgeryVascular Imaging CoreCore Lab StudiesCREST FAMILY

CREST FAMILY

Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial (CREST-2)

CREST-2 consists of two independent multicenter, randomized controlled trials of carotid revascularization and intensive medical management versus medical management alone in patients with asymptomatic high-grade carotid stenosis. One trial will randomize patients to endarterectomy versus no endarterectomy and another will randomize patients to carotid stenting with embolic protection versus no stenting. All participants receive intensive medical management.

The Core Lab’s role in this trial is to provide quality control of duplex ultrasound imaging by reviewing the studies to ensure that enrollment criteria is achieved, and to provide reporting and interpretation of various radiologic images (CT, MR, and catheter-based angiograms) by the appropriate physicians. The Core Lab also serves an image storage and record keeping role in this trial. 

  • Funding: National Institute of Neurological Disorders and Stroke-NIH
  • Imaging Core PI: Brajesh K Lal, MD
  • VIC Staff: John Yokemick, Brian Caraballo, Janice Martinez-Delcid, Matt Chrencik

 

 

CREST–Hemodynamics (CREST-H)

CREST H

A sub study of CREST-2 using CT and MR brain perfusion to assess hemodynamic imbalances resulting from carotid stenosis.

The Core Lab receives these images and distributes them to the appropriate sites for interpretation.

  • Funding: National Institute of Neurological Disorders and Stroke-NIH
  • Imaging Core PI: Brajesh K Lal, MD
  • VIC Staff: John Yokemick, Brian Caraballo, Janice Martinez-Delcid

 

 

CREST-Plaque Imaging (CREST-M)

Plaque imaging

A sub study of CREST-2 assessing carotid plaque morphology from MR angiograms.

The Core Lab receives, post-processes and interprets ultrasound and MRI carotid plaque studies to provide measurements of plaque geometry, tissue composition, strain and stress patterns.

  • Funding: National Institute of Neurological Disorders and Stroke-NIH
  • Imaging Core PI: Brajesh K Lal, MD
  • VIC Staff: John Yokemick, Brian Caraballo, Janice Martinez-Delcid
  • Staff: Matt Chrencik, Brian Caraballo 

 

 

Grey Scale Median (GSM) Analysis

A sub-study utilizing images obtained from CREST-2 subjects. Plaque boundaries are identified from 2D-DUS B-mode images. Using a histologically validated software, the GSM of the plaque, total plaque area, and area of individual tissue constituents are quantified.

  • Funding: National Institute of Neurological Disorders and Stroke-NIH
  • Imaging Core PI: Brajesh K. Lal, MD
  • Staff: John Yokemick, Matt Chrencik, Janice Martinez-Delcid

 

 

CREST-Life Line Screening (CREST-LLS) 

This is a program supplementing the CREST-2 trial using the Life Line Screening Company to enhance enrollment in CREST-2, particularly women and minorities.

The Core Lab is involved in the coordination and referral of patients with positive screening results to the various CREST-2 sites based on screening duplex ultrasonography performed across the country.

  • Funding: National Institute of Neurological Disorders and Stroke-NIH

  • PI: Brajesh Lal, MD

  • Coordinator: Frederick Durham