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Neurology. 2017 May 23;88(21):2061-2065. doi: 10.1212/WNL.0000000000003956. Epub 2017 Apr 26.

Asymptomatic carotid stenosis: Medicine alone or combined with carotid revascularization.

Author information

1
From the Novant Health Forsyth Comprehensive Stroke Center (D.V.H.), Winston Salem, NC; Cardiovascular Associates of the Southeast (G.S.R.), Birmingham, AL; Massachusetts General Hospital (K.G.R.), Boston; Main Line Health System/Lankenau Heart Institute (W.A.G.), Wynnewood, PA; Ochsner Medical Institutions (C.J.W.), New Orleans, LA; University of Pittsburgh Medical Center (T.G.J., B.T.J.), PA; University of Wisconsin School of Medicine and Public Health (J.S.M.), Madison; University of Maryland Medical Center (B.K.L.), Baltimore, MD; Miami Cardiac and Vascular Institute (B.T.K., G.D.); and Mayo Clinic (T.G.B.), Jacksonville, FL. dvheck66@gmail.com.
2
From the Novant Health Forsyth Comprehensive Stroke Center (D.V.H.), Winston Salem, NC; Cardiovascular Associates of the Southeast (G.S.R.), Birmingham, AL; Massachusetts General Hospital (K.G.R.), Boston; Main Line Health System/Lankenau Heart Institute (W.A.G.), Wynnewood, PA; Ochsner Medical Institutions (C.J.W.), New Orleans, LA; University of Pittsburgh Medical Center (T.G.J., B.T.J.), PA; University of Wisconsin School of Medicine and Public Health (J.S.M.), Madison; University of Maryland Medical Center (B.K.L.), Baltimore, MD; Miami Cardiac and Vascular Institute (B.T.K., G.D.); and Mayo Clinic (T.G.B.), Jacksonville, FL.

Abstract

Two positive randomized trials established carotid endarterectomy (CEA) as a superior treatment to medical management alone for the treatment of asymptomatic carotid artery stenosis. However, advances in medical therapy have led to an active and spirited debate about the best treatment for asymptomatic carotid stenosis. The Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis (CREST 2) trial aims to better define the best treatment for the average patient with severe asymptomatic carotid stenosis. Enrollment in the trial may be hampered by strong opinions on either side of the debate. It is important to realize that equipoise exists and that neither the old data on CEA nor the new data on optimal medical therapy provide a rigorous answer. The assumption that medical therapy has already been proven superior to revascularization procedures may hinder both enrollment in the trial and technical advancements in revascularization procedures.

PMID:
28446652
PMCID:
PMC5440242
DOI:
10.1212/WNL.0000000000003956
[Indexed for MEDLINE]
Free PMC Article

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