![]() household can again place an order to receive four more free COVID-19 rapid tests delivered directly to their home. Identity Theft and Online Security Show/hide Identity Theft and Online Security menu items.Unwanted Calls, Emails, and Texts Show/hide Unwanted Calls, Emails, and Texts menu items.Money-Making Opportunities and Investments.Jobs and Making Money Show/hide Jobs and Making Money menu items.Credit, Loans, and Debt Show/hide Credit, Loans, and Debt menu items.Shopping and Donating Show/hide Shopping and Donating menu items. ![]() Conservation strategies relevant to neurovascular practice include taking stroke patients directly to angiography when they present with high stroke scales, triaging patients with low stroke scales to magnetic resonance imaging and angiography avoiding CT all together, using emergent magnetic resonance imaging and angiography where available, and eschewing injection of the external carotid and vertebral arteries unless indicated. Physicians can institute conservation immediately, whereas increasing supply may take time and is not under direct physician control. 6 Conservation of contrast is also a useful approach to the ICM shortage. To avoid these challenges in the future, more attention should be given to supply chain diversity. A worsening or protracted ICM shortage might lead to compromises in care beyond elective procedures and have potentially disastrous consequences for patients with symptomatic large vessel occlusive strokes who depend on catheter-based therapies. We are hopeful that this latest challenge of ICM shortage will soon pass and that the gap in enrollment in the stenting trial versus the endarterectomy trial will narrow. 5 CREST-2 investigators have been resourceful, but there can be no stenting without contrast. 4 Adaptation to the pandemic has included development and formal testing of at-home monitoring of blood pressure and LDL cholesterol management. The CREST- 2 investigators have had to respond to many unexpected headwinds in the COVID-19 pandemic. The limitations of our survey include less than optimum response rates, lack of independent validation of responses, and the possibility that findings among CREST-2 investigators may not generalize to the larger community of interventionists. We found that nearly two thirds of investigators said that the ICM shortage had affected their site and that one third of those who reported having been affected by the ICM shortage reported that the shortage had affected elective carotid stenting. To the question “Is your healthcare center experiencing a shortage of intravenous contrast agent?,” 60% (41/68) responded “Yes” and 40% (27/68) responded “No.” Survey participants were then asked, “If yes, is this shortage affecting elective carotid stenting at your site?” To this question, 29% (11/38) responded “Yes” and 71% (27/38) responded “No.” A second survey was not sent because it would have had to be sent to all investigators and coordinators regardless of whether they had previously responded and because a second survey might generate different results reflecting a rapidly changing supply chain situation. The survey was intentionally very brief to encourage responses. The survey was closed to responses on May 19, 2022. On May 12, 2022, the CREST-2 Clinical Coordinating Center electronically mailed a 2-question pulse survey to CREST-2 physician investigators. ![]() 3 CREST-2 has 143 clinical performance sites across the US, Canada, and Spain. The reporting guideline used was the Standards for Reporting Qualitative Research. The purpose of this study was to gain insights into how the ICM shortage was affecting CREST-2 investigators.ĭata are available upon request to the corresponding author. ![]() As of June 6, 2022, a total of 973 patients have been enrolled in the stenting trial and 1101 in the endarterectomy trial. 2 CREST-2 leadership was particularly concerned about the effects of ICM shortage because in recent years, enrollment has been slower in the stenting trial than in the endarterectomy trial. CREST-2 includes randomization to stenting versus intensive medical management. In addition to adversely affecting clinical practice, an ICM shortage has the potential to compromise enrollment into clinical trials of revascularization. 1 Steps to prioritize indications and conserve contrast have the potential to restrict access to stenting for patients with asymptomatic atherosclerotic carotid stenosis. To address this challenge, radiology and other specialties utilizing contrast agents have been called on to prioritize indications for and conserve use of ICM. Shocks to supply chains triggered by the Covid-19 pandemic and a Covid-19 driven shutdown of manufacturing facility in Shanghai, China have resulted in a severe and unanticipated shortage in iodinated contrast media (ICM). ![]()
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