CREST-2 Trial Explained (Carotid Stenosis Treatment)

🎙️ 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.

Based on comments from experts, content on Wysdom, and the article cited below.

Brott TG, Howard G, Lal BK, Voeks JH, Turan TN, Roubin GS, et al. Medical management and revascularization for asymptomatic carotid stenosis. N Engl J Med. Published online November 21, 2025. doi:10.1056/NEJMoa2508800