Asymptomatic carotid stenosis: Medicine alone or combined with carotid revascularization. (23rd May 2017)

• Record Type: Journal Article
• Authors: Heck, Donald V.; Roubin, Gary S.; Rosenfield, Kenneth G.; Gray, William A.; White, Christopher J.; Jovin, Tudor G.; Matsumura, Jon S.; Lal, Brajesh K.; Katzen, Barry T.; Dabus, Guilherme; Jankowitz, Brian T.; Brott, Thomas G.
• Is Part Of: Neurology. Volume 88:Number 21(2017)
• Publication Date: 2017-05-23
• Subjects: Neurology -- Periodicals; Neurology -- Periodicals; Neurologie -- Périodiques; 616.8
• DOI: 10.1212/WNL.0000000000003956
• Languages: English
• ISSNs: 0028-3878

Abstract

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.