Carotid Stenting Plus IMM Reduces Stroke Risk in Asymptomatic Carotid Stenosis

Background: Whether to perform carotid endarterectomy or carotid artery stenting in asymptomatic patients with ≥70% internal carotid artery stenosis, compared with aggressive medical management alone, remains an unanswered question because there is equipoise regarding the best approach. The Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis (CREST-2) trial was designed to answer this question. Objective: To compare intensive medical management alone with carotid artery stenting or endarterectomy plus intensive medical management in asymptomatic patients with ≥70% carotid artery stenosis. Design/Participants: CREST-2 consisted of 2 parallel, observer-blinded randomized trials that enrolled patients with ≥70% asymptomatic internal carotid artery stenosis who were free of symptoms for ≥180 days. Methods: The stenting trial compared intensive medical management (IMM) alone (medical group) with carotid artery stenting plus IMM, whereas the endar more...