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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.
GLOSSARY
- ACAS=
- Asymptomatic Carotid Atherosclerosis Study;
- ACST=
- Asymptomatic Carotid Surgery Trial;
- ACT 1=
- Asymptomatic Carotid Stenosis Stenting vs Endarterectomy Trial;
- C2R=
- Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Registry;
- CAS=
- carotid stenting;
- CEA=
- carotid endarterectomy;
- CMS=
- Centers for Medicare Services;
- CREST=
- Carotid Revascularization Endarterectomy versus Stenting Trial;
- CREST 2=
- Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis;
- FDA=
- Food and Drug Administration;
- IMC=
- Interventional Management Committee;
- SAMMPRIS=
- Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis trial
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- Received September 1, 2016.
- Accepted in final form February 13, 2017.
- © 2017 American Academy of Neurology
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