Clinical Report: CREST-2 Findings Highlight Evolving Role of Carotid Artery Stenting

Overview

The CREST-2 trial provides evidence supporting carotid artery stenting (CAS) in patients with severe asymptomatic carotid stenosis. The study found a lower stroke rate in patients receiving CAS combined with intensive medical management compared to those receiving medical management alone.

Background

Carotid artery stenosis is a significant risk factor for stroke, making effective management crucial. The role of CAS in conjunction with intensive medical therapy is being evaluated in the context of treatment strategies for asymptomatic patients.

Data Highlights

Key Findings

• CAS combined with intensive medical management resulted in a 2.8% stroke/death rate at four years.
• Medical management alone had a 6.0% stroke/death rate, indicating a significant difference (p=0.02).
• Operator experience and careful patient selection were critical to achieving favorable outcomes.
• Only 9% of operators were approved on the first review of their credentialing submissions.
• Standardized procedural techniques were emphasized, including dual antiplatelet therapy and embolic protection.

Clinical Implications

Clinicians should consider operator experience and patient selection when determining treatment strategies for patients with severe asymptomatic carotid stenosis.

Conclusion

CREST-2 provides insights into the role of CAS in specific patient populations, emphasizing the importance of operator experience and procedural techniques.

Related Resources & Content

1. American College of Cardiology, CREST-2: Stents But Not Endarterectomy Reduced Stroke Risk For Asymptomatic CAS, 2025 -- CREST-2 Findings Highlight Evolving Role of Carotid Artery Stenting
2. Journal of Endovascular Therapy, Ten Years of European Experience With Roadsaver Carotid Stent: A Systematic Review of Literature and Exploratory Meta-Analysis
3. Vascular Medicine, ‘It works in practice, but does it work in theory?’ An important addition to the body of real-world evidence supporting carotid endarterectomy
4. Journal of Endovascular Therapy, In-Stent Stenosis or Occlusion After Carotid Artery Stenting in Patients Treated With Anticoagulants vs Antiplatelet Therapy
5. Frontiers in Cardiovascular Medicine — Transcervical carotid artery stenting compared to transfemoral carotid artery stenting and carotid endarterectomy: perioperative and short-term results from a single center
6. CREST-2: Stents But Not Endarterectomy Reduced Stroke Risk For Asymptomatic CAS - American College of Cardiology
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8. An international, multispecialty, expert-based Delphi Consensus document on controversial issues in the management of patients with asymptomatic and symptomatic carotid stenosis - PubMed