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<p>There has been controversy over the ideal management strategy for asymptomatic carotid artery stenosis. Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trials (CREST-2) evaluated whether adding carotid revascularisation to intensive medical therapy improves outcomes in patients with high-grade asymptomatic carotid artery stenosis. The study showed that carotid endarterectomy did not reduce the 4-year composite outcome compared with medical therapy alone, owing to higher early procedural risk that offset the lower late ipsilateral stroke rates. Carotid artery stenting on the other hand produced a statistically significant benefit, despite small periprocedural risks. Overall, intensive medical therapy achieved low disabling stroke rates, supporting selective rather than routine use of revascularisation.</p>

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Stenting, surgery, or medical therapy alone in asymptomatic carotid artery stenosis? Interpreting the CREST-2 findings

  • 期刊论文

  • 发表日期：

    2026年1月14日

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  • Pradeep Narayan

摘要

There has been controversy over the ideal management strategy for asymptomatic carotid artery stenosis. Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trials (CREST-2) evaluated whether adding carotid revascularisation to intensive medical therapy improves outcomes in patients with high-grade asymptomatic carotid artery stenosis. The study showed that carotid endarterectomy did not reduce the 4-year composite outcome compared with medical therapy alone, owing to higher early procedural risk that offset the lower late ipsilateral stroke rates. Carotid artery stenting on the other hand produced a statistically significant benefit, despite small periprocedural risks. Overall, intensive medical therapy achieved low disabling stroke rates, supporting selective rather than routine use of revascularisation.