Abstract
There has been controversy over the ideal management strategy for asymptomatic carotid artery stenosis. Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trials (CREST-2) evaluated whether adding carotid revascularisation to intensive medical therapy improves outcomes in patients with high-grade asymptomatic carotid artery stenosis. The study showed that carotid endarterectomy did not reduce the 4-year composite outcome compared with medical therapy alone, owing to higher early procedural risk that offset the lower late ipsilateral stroke rates. Carotid artery stenting on the other hand produced a statistically significant benefit, despite small periprocedural risks. Overall, intensive medical therapy achieved low disabling stroke rates, supporting selective rather than routine use of revascularisation.