Revascularization of Asymptomatic Carotid Artery Stenosis: Cognitive Results of the CREST-2 Randomized Trials.

In 2366 US patients with 70% or greater asymptomatic carotid stenosis, carotid stenting or endarterectomy plus intensive medical management did not significantly improve cognitive composite z scores at 4 years.

• Why it matters: Asymptomatic carotid stenosis is linked to diminished cognition, but it was unclear whether revascularization could improve cognitive outcomes beyond intensive medical management alone.
• What they did: CREST-2 prespecified cognitive outcomes randomized patients 35 years or older to CAS + IMM vs IMM alone or CEA + IMM vs IMM alone, administering five telephone cognitive tests at baseline and annually up to 4 years.
• The result: Fully adjusted composite z scores at 4 years showed no significant between-group differences for CAS (0.03 [95% CI, -0.09 to 0.15]) or CEA (0.02 [95% CI, -0.09 to 0.14]), and no significant differences appeared on any individual test.