🎙️ CREST-2 Results—A Paradigm Shift in Carotid Care
This episode unpacks the long-awaited results of the CREST-2 Trial, a landmark study that challenges the standard of care for treating asymptomatic carotid stenosis (narrowing of the carotid artery without recent stroke symptoms).
The Big Question: Does adding invasive revascularization (Endarterectomy or Stenting) to Intensive Medical Management (IMM) prevent more strokes than medication and lifestyle changes alone?
The Clear Verdict: After 10 years of research, the trial was stopped early for "futility," meaning the results were conclusive: there was no significant difference in stroke or death rates between the surgery/stenting group and the medication-only group.
The Power of Medical Therapy: The study proves that modern medical management—including tight blood pressure control (target <130/80) and high-intensity statins—is incredibly effective on its own, rendering the risks of procedural intervention unnecessary for asymptomatic patients.
The Procedure Gap: While Endarterectomy (surgery) matched the safety of medical management, Carotid Stenting (CAS) performed worse, showing a higher rate of immediate, non-disabling strokes compared to medication alone.
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