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Authors Heck DV, Roubin GS, Rosenfield KG, Gray WA, White CJ, Jovin TG, Matsumura JS, Lal BK, Katzen BT, Dabus G, Jankowitz BT, Brott TG
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Journal Neurology Volume: 88 Issue: 21 Pages: 2061-2065
Publish Date 2017 May 23
PubMed ID 28446652
PMC ID 5440242
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.

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