Asymptomatic Carotid Revascularization May Be Justified, But Not to Improve Cognition
https://jamanetwork.com/journals/jama/fullarticle/2854200
Stroke is a feared complication of atherosclerotic carotid artery stenosis. After years of debate regarding the value of revascularizing asymptomatic carotid stenosis in the modern era of intensive medical prevention with antiplatelet therapy and high-intensity statins, the CREST-2 trial revisited this question in a pair of randomized clinical trials: one trial comparing carotid endarterectomy plus best medical management vs medical therapy alone and the other comparing carotid artery stenting plus best medical management vs medial therapy alone. The topline findings showed that carotid artery stenting, but not carotid endarterectomy, significantly reduced the risk of the primary outcome of a composite of stroke or death within 44 days or ipsilateral stroke within up to 4 years compared with medical therapy alone among patients without contralateral stenosis who were good procedural candidates.
September 16, 2026 707
