Medical Treatment or Intervention for Asymptomatic Carotid Stenosis? Interpreting CREST-2

Older randomized trials have shown modest benefit for carotid endarterectomy for selected patients with asymptomatic carotid stenosis compared with medical treatment. However, improvements in contemporary medical therapy may have negated the benefit of carotid endarterectomy, and no large randomized trials comparing stenting with modern medical treatment have been completed. The recently reported CREST-2 trial (Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trials) addressed these evidence gaps. We describe the main results of CREST-2 and our interpretation of the findings for clinical practice.