Neurology · 3 h ago
Carotid Revascularization Did Not Improve Cognition in CREST-2
Prespecified cognitive outcomes from the CREST-2 randomized trials found no significant cognitive benefit from carotid stenting or endarterectomy plus intensive medical management compared with medical management alone. The analysis included 2,165 patients with severe asymptomatic carotid stenosis and assessed cognition for up to four years.
- 2,165 participants completed cognitive assessments.
- Neither procedure improved four-year composite cognitive scores.
- No significant differences appeared on individual cognitive tests.
- The analysis evaluated cognition, not other clinical outcomes.
This prespecified secondary analysis of the CREST-2 randomized clinical trials evaluated cognition in adults aged 35 years or older with at least 70% asymptomatic carotid stenosis. The trials compared carotid artery stenting plus intensive medical management (IMM) with IMM alone, and carotid endarterectomy plus IMM with IMM alone. Of 2,366 US participants, 2,165 (91.5%) completed cognitive assessments. Five tests covering learning, memory, executive function, attention and processing speed were administered at baseline and annually for up to four years; the primary analysis was the adjusted composite score at four years.
At four years, the adjusted between-group difference in composite cognitive scores was 0.03 standard deviations for stenting versus IMM alone (95% CI, −0.09 to 0.15) and 0.02 for endarterectomy versus IMM alone (95% CI, −0.09 to 0.14). Neither comparison was statistically significant, and no significant differences were found on individual tests. The prespecified minimal clinically important difference was 0.50 standard deviations.
These findings do not support cognitive improvement as a demonstrated benefit of either revascularization procedure in this population. The report concerns cognitive outcomes; it does not establish the procedures’ effects on other clinical outcomes. Follow-up for cognitive testing extended to four years.
In practice
For adults with at least 70% asymptomatic carotid stenosis represented in CREST-2, adding carotid stenting or endarterectomy to intensive medical management did not significantly improve cognitive test performance compared with medical management alone through four years. The adjusted composite-score differences were small, with confidence intervals spanning no effect, and no individual test showed a significant difference. These results do not demonstrate cognitive benefit as a reason to choose revascularization; the analysis addresses cognition and does not determine the procedures’ effects on other outcomes.
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JAMA: Revascularization of Asymptomatic Carotid Artery Stenosis ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.