Friday, July 29, 2016
After he retired, Don Cochran, 68, of Washington, was encouraged by his wife to become more active and join a gym. Not only did he join, but he also enlisted the expertise of a personal trainer.
In the spring of 2015, while at the gym, he became light-headed. The next thing he remembered, there were EMTs gathered around him as he regained consciousness. The EMTs determined that Don’s blood pressure dropped so low that he passed out. They encouraged him to follow up with a doctor.
Don met with Robert Safian, M.D., an interventional cardiologist and director, Center for Innovation and Research in Cardiovascular Diseases, Beaumont Hospital in Royal Oak. After an ultrasound of his carotid arteries, it was discovered he had about a 90 percent blockage on the left side.
Because Don’s artery blockage was greater than 70 percent and he had no symptoms attributed to the blockage, Dr. Safian told Don he was an ideal candidate to participate in a national stroke prevention study, CREST-2. Although the drop in blood pressure was likely related to strenuous exercise, and not the blocked artery, the imaging done due to this episode may have saved his life. It is possible to have severe stenosis, or narrowing of the arteries with no symptoms.
In June 2015, Don found out he met the study criteria and was enrolled in CREST-2 at Beaumont, Royal Oak. He learned study participants cannot choose what type of treatment procedure they are getting because they are randomized.
Participants meet with their doctor to discuss which treatment is better suited to their condition, either carotid stenting or carotid endarterectomy, and, once that is decided, they are randomly placed in one of two prevention programs:
- intensive medical management
- intensive medical management with carotid endarterectomy or intensive medical management with carotid stenting.
Don was placed in the intensive medical management with carotid stenting program, and after his stenting procedure, was discharged the next day.
Beaumont, Royal Oak is one of 120 medical centers participating in CREST-2. Nearly 2,500 participants are being recruited from across the United States and Canada. CREST-2, is supported by the National Institutes of Health.
Today, Beaumont is still seeking participants for the CREST-2 study. To qualify, participants, like Don, must:
- be at least 35 years old
- have a significant narrowing of one carotid artery with at least 70 percent blockage
- have no history of stroke or transient ischemic attack( TIA), within the past six months
Carotid endarterectomy is a surgical procedure where surgeons clean out and repair a main artery supplying blood to the brain. Carotid stenting is a procedure in which a metal device called a stent is placed in a narrowed part of the carotid artery to cover the plaque and hold the vessel open.
The CREST-2 carotid surgery and carotid stenting procedures are only performed by physicians who have demonstrated safety and expertise in these procedures. All participants receive intensive medical management.
“To date, no research has been conducted to compare the treatment differences between intensive medical management and two procedures - carotid surgery and stenting. CREST-2 is intended to compare the two procedures to intensive medical management in patients without recent stroke and without stroke warning signs,” said O. William Brown, M.D., lead study doctor and section head, Vascular Surgery, Beaumont, Royal Oak. “Most importantly, we hope to gain a better understanding of whether intensive medical management alone, which includes lifestyle modifications, can treat this condition. The information from this study will help us learn more about the best treatment for stroke prevention.”
There are several risk factors for stroke, including high blood pressure, high cholesterol, diabetes, tobacco use, excess body weight and physical inactivity. In CREST-2, this stroke prevention method includes using aspirin to prevent blood clot formation, drugs to reduce blood pressure/bad cholesterol and a personal risk-modification coach to review ways to quit tobacco, manage weight and increase physical activity.
Since his medical emergency at the gym more than 14 months ago, Don has had a major blockage opened in his carotid artery, eats better, exercises and has lost 12 pounds. He’s now down to 168 pounds. He rides his bike with his wife, plays golf, goes fishing and enjoys travel.
As for participating in CREST-2 he said, “It’s been good and it’s easy to participate.” All participants get an annual exam which includes an ultrasound of the carotid arteries and blood work. He also receives periodic calls from a life coach to talk about blood pressure, his weight and exercise.
“It was probably a good thing that I passed out at my gym,” said Don.
For more information on the CREST-2 study at Beaumont, Royal Oak and patient participation criteria, contact Kelly Slade, RN at 248-551-0194. Information is also available at www.crest2trial.org.