Credentialing and training of CREST stentors.

A report describing the credentialing and training of stentors in the Carotid Revascularization Endarterectomy vs Stenting Trial (CREST) was recently presented at the 2009 International Stroke Conference of the American Heart Association (San Diego, Calif, Feb 18-20, 2009). CREST is an ongoing randomized clinical trial comparing carotid endarterectomy and carotid artery stenting (CAS) in stroke prevention. To limit the learning curve effect, trial investigators have adopted a two-step credentialing and training algorithm. Initially, prospective investigators submit data on their most recent 10 to 30 consecutive CAS cases to a multidisciplinary interventional management committee (IMC). If approved by the IMC, candidates enter a lead-in credentialing phase with animal training or didactic and hands-on training, or both, before performing up to 20 CAS lead-in cases for review by the IMC. After final approval, operators may enroll patients in the randomized phase. The IMC does have the prerogative to exempt operators from the lead-in phase if they have demonstrated sufficient CAS experience in other trials. Of the 429 operators who applied, 225 (52%) were eventually approved for randomization. Initially, 117 oper-