SELECTION AND ACTIVATION OF SITES IN A LARGE MULTI-CENTER RANDOMIZED CLINICAL TRIAL (P6.280)

Objective: To summarize the site selection process in the Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial (CREST-2). Background: Careful selection and timely activation of clinical sites in multicenter clinical trials is critical for successful enrollment, subject safety, and generalizability of results. Design/Methods: In CREST-2, a multidisciplinary Site Selection Committee evaluated applicants referred via participation in CREST, CREST principal investigators (PIs) and other investigators, StrokeNet and industry partners. Data for consideration included performance metrics in CREST and other carotid trials and a site selection questionnaire containing information on the investigators as well as quantitative data on carotid procedures performed. Results: The Committee met bi-weekly for 36 months (n=64 meetings). Applications from 176 sites between March 2014 and July 2016 were evaluated: 153 were approved, 7 are under Committee review, 5 were approved but withdrew, 5 were placed on a waiting list, and 6 were rejected. One-hundred-four sites have completed the regulatory and training requirements to randomize: 51 (49%) academic medical centers, 31 (30%) private hospital-based centers, 16 (15%) private office-based practices, and 6 (6%) Veterans Administration medical centers. The mean times from application-to-approval was 5.2 weeks (interquartile range, 1.9, 6.2), and from approval-to-randomization status was 46.7 weeks (interquartile range, 35.4, 51.7). Specialties of the 104 site PIs are vascular surgery for 35 (33.7%), cardiology for 30 (28.8%), neurology for 25 (24%), neurosurgery for 8 (7.7%), interventional radiology for 4 (3.8%), and interventional neuroradiology for 2 (1.9%). Conclusions: Careful site selection is time-consuming for prospective sites and for trial leadership. The mean time from application-to-site-approval was 5.2 weeks, and the mean time for completing regulatory and training requirements was 46.7 weeks. However, subject enrollment by teams from a wide range of medical centers led by a multi-disciplinary cohort of PIs will promote the generalizability of trial results. Disclosure: Dr. Demaerschalk has nothing to disclose. Dr. Brown has nothing to disclose. Dr. Howard has nothing to disclose. Dr. Tom has nothing to disclose. Dr. Longbottom has nothing to disclose. Dr. Voeks has nothing to disclose. Dr. Kadiric has nothing to disclose. Dr. Meschia has received personal compensation in an editorial capacity for the European Journal of Neurology. Dr. Brott has received personal compensation for activities with 3D Communications and Edwards Lifesciences, LLC as a consultant.