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    Health Screening Program to Enhance Enrollment of Women and Minorities in CREST-2.

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    Author
    Lal, Brajesh K
    Meschia, James F
    Jones, Michael
    Aronow, Herbert D
    Lackey, Angelica
    Lake, Rachel
    Howard, George
    Brott, Thomas G
    Date
    2022-01-05
    Journal
    Stroke
    Publisher
    American Heart Association
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.1161/STROKEAHA.120.033226
    Abstract
    Background and purpose: The CREST-2 (Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial) consists of 2 parallel randomized stroke prevention trials in patients with asymptomatic high-grade stenosis of the cervical carotid artery. The purpose of this report is to detail the outcomes of a health screening effort to increase trial enrollment of women and minorities. Methods: Life Line screening (LLS) conducts nationwide screening for vascular disease. Screenings within a 50-mile radius of each CREST-2 center were identified for participation in a joint CREST-LLS program over the course of one year (November 2018 to October 2019) whereby patients with an abnormal carotid ultrasound were referred to the local CREST-2 center for further workup, management, and potential consideration for trial enrollment. Results: LLS completed the screening of 588 198 individuals in 29 732 zip codes across the United States. Of those, 230 021 individuals were screened at events occurring near a CREST-2 clinical center and 646 (0.3%) were found to have abnormal carotid ultrasound findings. Each of the 646 individuals was contacted by CREST-LLS program staff for permission to be referred to their local CREST-2 center; 200 (31%) consented to be contacted by CREST-2. Of those, 39 (19.5%) agreed to be, and were, evaluated at their local CREST-2 center. High-grade stenosis was confirmed in 27 patients. A total of 3 patients were eligible for the trial and were enrolled, one woman but no racial/ethnic minorities. Conclusions: The LLS program appears to identify community-living individuals with high-grade carotid stenosis through ultrasonography. However, the prevalence of abnormal carotid findings was low. In addition, screening and offering participation into the CREST-2 trial had no substantial impact on the proportion of women and minorities enrolled in the trial. Additional innovative strategies are needed to promote enrollment of diverse patients with carotid stenosis into stroke prevention trials.
    Keyword
    carotid arteries
    carotid endarterectomy
    carotid stenosis
    prevalence
    ultrasonography
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/17948
    ae974a485f413a2113503eed53cd6c53
    10.1161/STROKEAHA.120.033226
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