Aortic & peripheral vascular diseaseSecondary analysis
Revascularization in Asymptomatic Carotid Artery Stenosis With Hemodynamic Impairment and Cognitive Outcomes
- Substudy of the CREST-2 randomised controlled trial
- multicentre
- phase 3
- 61 sites in North America
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
Primary result
As reported in the abstract
Composite cognitive z score over 1 year, in those with reduced baseline cognition (n = 51)
Revascularization
−1.17
mean · SD 0.47
IMM alone
−1.01
mean · SD 0.97
- Treatment group · revascularization vs IMM alone; adjusted for treatment group × hemodynamic status interaction and other covariates; no difference
- adjusted difference in cognitive z score −0.15 SD (95% CI −0.54 to 0.24)
- Interaction · treatment group × hemodynamic status interaction; not significant
- β estimate 0.018 (95% CI −0.025 to 0.061); P = 0.40
Original publication
Revascularization in Asymptomatic Carotid Artery Stenosis With Hemodynamic Impairment and Cognitive Outcomes. JAMA. Published 16 September 2026. doi:10.1001/jama.2026.13384
Summarised from the published abstract; every number is checked against it