Asymptomatic Carotid Revascularization May Be Justified, but Not to Improve Cognition

Topline CREST-2 results show carotid artery stenting significantly reduced the composite endpoint of stroke or death compared with medical therapy alone in asymptomatic patients, while carotid endarterectomy did not show a significant difference. The composite endpoint included stroke or death within 44 days, or ipsilateral stroke within up to 4 years. Participants had no contralateral stenosis, were suitable procedural candidates, and received intensive medical prevention. The original article argues that even if asymptomatic carotid revascularization may be justified, it should not aim to improve cognition.