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On November 21, the landmark CREST-2 trial was published in the prestigious New England Journal of Medicine . This two-arm study evaluated whether adding carotid artery stenting or carotid endarterectomy to optimal medical therapy provides additional benefit in patients with ≥70% carotid stenosis and no prior cerebrovascular events.
The study demonstrated a statistically significant benefit when carotid artery stenting was added to optimal medical therapy—an effect not observed in the surgical endarterectomy arm.
Carotid artery stenting combined with medical therapy reduced the risk of ischemic events at 4-year follow-up compared with medical therapy alone.
For the first time, this trial provides evidence supporting the benefit of neurointerventional treatment for asymptomatic carotid stenosis, opening the door for patients to access a minimally invasive procedure associated with short hospital stays and rapid recovery.
Undoubtedly, this new evidence represents an important advancement for the neurointerventional community. However, it also places a responsibility on neurointerventionalists to maintain high expertise and low complication rates to ensure that the benefits demonstrated in this study are effectively translated to our patients.
Reported by Luis Contreras Seitz
