Aortic & peripheral vascular disease
Revascularization of Asymptomatic Carotid Artery Stenosis: Cognitive Results of the CREST-2 Randomized Trials
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
Methodological detailsprespecified 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
- 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
Primary result
As reported in the abstract
Fully adjusted composite z score
CAS + IMM vs IMM alone (CAS trial)
CAS + IMM
0.22
95% CI 0.13–0.30
IMM alone (CAS trial)
0.18
95% CI 0.09–0.27
Estimate (95% CI)
Between-group differenceCAS trial
0.03(−0.09 to 0.15)
CEA + IMM vs IMM alone (CEA trial)
CEA + IMM
0.25
95% CI 0.17–0.33
IMM alone (CEA trial)
0.23
95% CI 0.15–0.32
Estimate (95% CI)
Between-group differenceCEA 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: Cognitive Results of the CREST-2 Randomized Trials. JAMA. Published 16 September 2026. doi:10.
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