The CREST-2 study looked at people with severe carotid artery narrowing (70% or more) who had no symptoms such as stroke or TIA. The study compared three treatment strategies:
- Intensive medical therapy alone (blood pressure control, cholesterol lowering, lifestyle changes)
- Medical therapy plus stenting
- Medical therapy plus surgery (carotid endarterectomy)
Key results after four years:
Stenting together with medical therapy resulted in fewer strokes than medical therapy alone.
Surgery did not show a clear advantage.
Across all treatment groups, the overall stroke risk was low.
What this means for patients:
Many people with severe but asymptomatic carotid stenosis can be safely managed with intensive medication alone. In selected cases, stenting may be helpful. Surgery may be considered in specific situations but did not show a clear overall benefit in this study.
Every case should be evaluated individually using modern imaging and a personalised risk assessment.
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