Aortic & peripheral vascular diseaseSecondary analysis
Revascularization of Asymptomatic Carotid Artery Stenosis
- Secondary analysis of the CREST-2 randomised trials
- prespecified cognitive secondary outcomes
- 2 parallel trials
- blinded central telephone assessment
- 146 clinical sites
4954 test batteries after baseline; mean follow-up 2.24 (SD, 1.09) years
Authors' conclusion
In patients with severe asymptomatic carotid artery stenosis, revascularization with either CAS or CEA plus IMM, compared with IMM alone, did not significantly improve cognitive function at up to 4 years of follow-up.
Study context
- Population
- Patients aged ≥35 years with ≥70% asymptomatic carotid stenosis, US2,165 (91.5%) in cognitive assessments
- Participants
- 2,366 patients
- Comparison
- Carotid revascularization + IMM vs IMM alone
- CAS + IMMn = 529
- IMM alone (CAS trial)n = 549reference
- CEA + IMMn = 543
- IMM alone (CEA trial)n = 544reference
- Primary endpoint
- Fully adjusted composite cognitive z score (5 tests; MCID 0.50 SD)
- Follow-up
- Up to 4 years
Primary result
As reported in the abstract
Fully adjusted composite z score
CAS + IMM
0.22
95% CI 0.13–0.30
IMM alone (CAS trial)
0.18
95% CI 0.09–0.27
CEA + IMM
0.25
95% CI 0.17–0.33
IMM alone (CEA trial)
0.23
95% CI 0.15–0.32
Between-group difference (95% CI)
CAS + IMM vs IMM alone (CAS trial)CAS trial
0.03(−0.09 to 0.15)
CEA + IMM vs IMM alone (CEA trial)CEA trial
0.02(−0.09 to 0.14)
Secondary outcomes
Individual cognitive tests
- No significant differences between revascularization + medical management vs IMM alone for any individual test
Original publication
Revascularization of Asymptomatic Carotid Artery Stenosis. JAMA. Published 16 September 2026. doi:10.1001/jama.2026.14703
Summarised from the published abstract; every number is checked against it