Revascularization of Asymptomatic Carotid Artery Stenosis: Cognitive Results of the CREST-2 Randomized Trials.
Ronald M Lazar, James F Meschia, Lloyd J Edwards et al.
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In 30 seconds
This prespecified cognitive-outcomes analysis of the multicentre, randomised CREST-2 trials assessed patients aged 35 years or older with at least 70% asymptomatic carotid stenosis. It compared carotid stenting plus intensive medical management (IMM) with IMM alone, and, in a separate trial, carotid endarterectomy plus IMM with IMM alone. Among 2165 participants completing cognitive assessments, neither procedure significantly improved the adjusted composite cognitive score at 4 years: between-group differences were 0.03 (95% CI, -0.09 to 0.15) for stenting and 0.02 (95% CI, -0.09 to 0.14) for endarterectomy.
Key findings
- At 4 years, the adjusted composite-score difference was 0.03 (95% CI, -0.09 to 0.15) for stenting plus IMM versus IMM alone.
- For endarterectomy plus IMM versus IMM alone, the 4-year adjusted composite-score difference was 0.02 (95% CI, -0.09 to 0.14).
- No significant differences were found between revascularization and IMM alone on any of the five individual cognitive tests.
Why it matters
Cognitive impairment has been associated with asymptomatic carotid stenosis, but this randomised evidence does not show that revascularization improves cognition over medical management during follow-up of up to 4 years. The findings help clarify that cognitive benefit was not demonstrated as an outcome of either procedure in this population.
What to keep in mind
Follow-up averaged 2.24 (SD, 1.09) years, although the prespecified primary comparison was at 4 years; the abstract reports cognitive outcomes only through up to 4 years.