Aortic & peripheral vascular disease
Revascularization in Asymptomatic Carotid Artery Stenosis With Hemodynamic Impairment and Cognitive Outcomes: The CREST-H Substudy of the CREST-2 Randomized Clinical Trial
Authors' conclusion
In this substudy of a randomized clinical trial, there was no differential effect of revascularization vs IMM alone on cognition over 1 year by cerebral hemodynamic status among those with baseline reduced cognition, suggesting that revascularization does not improve cognitive dysfunction by restoring flow to the brain in chronic asymptomatic carotid stenosis.
Study context
- Population
- Adults aged 35–86 years without dementia, with unilateral asymptomatic internal carotid artery (ICA) stenosis ≥70%; primary analysis in those with reduced baseline cognition (z score ≤−1.0 SD)291 with complete data
- Participants
- 392 adults
- Comparison
- Carotid revascularization plus intensive medical management (IMM) vs IMM alone
- Revascularizationn = 25
- IMM alonen = 26reference
- Primary endpoint
- Difference in composite:
- Cognitive z score (5 cognitive tests)
- Interaction of treatment group × baseline hemodynamic impairment (time-to-peak (TTP) delay) among those with reduced baseline cognition
- Follow-up
- 1 year
Methodological detailsmulticentre, phase 3, 61 sites in North America
- Multicentre
- Phase 3
- 61 sites in North America
Primary result
As reported in the abstract
Adjusted difference in cognitive z score
−0.15 SD
95% CI −0.54 to 0.24
Treatment group · revascularization vs IMM alone; adjusted for treatment group × hemodynamic status interaction and other covariates; no difference
Β estimate
0.018
95% CI −0.025 to 0.061P = 0.40
Interaction · treatment group × hemodynamic status interaction; not significant
Revascularization
−1.17
mean · SD 0.47
IMM alone
−1.01
mean · SD 0.97
Original publication
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