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CREST2 Carotid Artery Disease patient.
Gary Roubin, M.D., PhD., Cardiovascular Associates
In 2003, Dominick Giovannelli was constantly on the move and traveling a lot for work. During a business trip, Dominick was running through the airport when he felt a pain in his arm and tightness in his chest. His internist of twenty years referred him to Elizabeth Branscomb, M.D., cardiologist at Cardiovascular Associates (CVA) and affiliated with Brookwood Baptist Medical Center. “I blew through the stress test but Dr. Branscomb knew something was wrong and asked that I agree to an echocardiogram,” he says. “I went into the echocardiogram in the morning thinking I could go back to work right afterwards and they ended up finding a 90 percent blockage. At 54 years old, I had a quadruple bypass and was primed for a stroke. She really did save my life”
Gary Roubin, M.D., PhD. Dominick was followed carefully by Dr. Branscomb who appreciated that he, like all patients with cardiovascular disease, was at risk of blockages in other arteries and especially blockages in the carotid arteries in the neck that may cause a stroke. In October 2015, routine ultrasound testing of the carotid arteries detected a new, severe but asymptomatic blockage in Dominick’s artery. Based on these findings, his cardiologist recommended that he see Gary Roubin, M.D., an interventional cardiologist with CVA and pioneer of coronary and carotid stents. Dr. Roubin is an internationally recognized expert in the treatment of carotid artery disease and a lead investigator for the National Institutes of Health CREST2 Study.
The study is determining if patients can get the same benefit of avoiding stroke from “state of the art,” unique medical management protocols rather than a revascularization procedure. These optimal medical approaches have provided data that suggests they may be as effective as revascularization in asymptomatic patients. Revascularization in CREST2 is offered by surgical plaque removal with carotid endarterectomy or alternative percutaneous, non – surgical stent placement. Optimal medical management has the potential advantage of avoiding the risk associated with both of these revascularization procedures.
Dr. Roubin asked Dominick to be part of the CREST 2 program in which Brookwood Baptist Medical Center ranks as the third highest hospital in the country for enrollments to the study. “Participation in the CREST-2 Trial has sharpened the focus of our medical center on excellence in carotid disease management,” says Dr. Roubin. “The medication approach has been very effective but until we finish the CREST 2 Study – we just won’t know the best treatment to offer our patients.”
“At first, I was apprehensive because of the randomization of therapy,” says Dominick. “Dr. Roubin was reassuring and spoke to me in a way that helped me understand what would be happening. He explained both options were excellent and potentially ‘win –win’ situations. The fact that he has led the field in cardiac and vascular advancements for three decades really made me feel at ease.” Dominick agreed to take part in the CREST 2 program in early 2016 and in addition to receiving optimal medications he was randomly assigned to receive treatment with a carotid stent. Dr. Roubin utilized his latest innovation, a dual stent technique in Dominick’s right carotid artery. “The staff was just awesome,” says Dominick. “I can’t say enough about how impressed I am with Dr. Roubin.”
Dominick is happy he ended up with the stents and is feeling great as he prepares to retire next year. He is grateful to Dr. Roubin and his staff for the high quality of care he received throughout this journey. “The care that Dr. Roubin has for his patients is outstanding and he has so much to give.”