Carotid Revascularization Did Not Improve Cognition Over IMM Alone

This CREST-2 substudy examined whether revascularization (endarterectomy or stenting) plus intensive medical management improved cognition, compared with intensive medical management alone, in patients with asymptomatic high-grade carotid stenosis and cerebral hemodynamic impairment. Among 291 participants with complete data, including 51 with reduced baseline cognition, the trial reported no significant difference in cognitive z scores between treatment groups over one year, and no significant interaction between treatment and degree of hemodynamic impairment. The authors state this suggests revascularization does not improve cognitive dysfunction by restoring cerebral blood flow in chronic asymptomatic carotid stenosis.

Most relevant for: Patients with asymptomatic high-grade internal carotid artery stenosis, particularly those with reduced baseline cognition or cerebral hemodynamic impairment.

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