Stroke is one of the leading causes of death and long-term disability around the world. It happens when blood flow to part of the brain is blocked or reduced, causing brain cells to die from lack of oxygen.
One common cause of stroke is a narrowing of the carotid arteries, which are the main blood vessels that carry blood to the brain. This narrowing, also known as carotid stenosis, is caused by a buildup of fatty plaque along the artery walls. If a piece of this plaque breaks off or blocks the artery, it can trigger a stroke.
In many people, carotid artery narrowing develops slowly and without clear symptoms. These people may feel completely fine and may not even know that their arteries are severely blocked.
Because of this, doctors have long debated the best way to treat people with severe narrowing who do not show any warning signs of a stroke, such as weakness, speech problems, or vision loss. For decades, surgery was often recommended as a way to remove plaque and prevent a future stroke.
However, improvements in medicine, including better blood pressure drugs, cholesterol control, and lifestyle changes, have made doctors question whether invasive procedures are still necessary for patients without symptoms.
To answer this important question, an international team of researchers led by the Mayo Clinic carried out the largest and most detailed study ever done on this topic.
The study, called the Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial, or CREST-2, compared modern treatment approaches in people with severe carotid artery narrowing but no recent stroke symptoms.
The results were so important that they were published in one of the world’s most respected medical journals, the New England Journal of Medicine.
The research was carried out in 155 medical centers across five countries, including the United States, Canada, Australia, Israel, and Spain. More than 2,400 adults took part in two closely related clinical trials. All participants had severe narrowing of 70 percent or more in at least one carotid artery but had not had a stroke or a mini-stroke in the previous six months.
In the first trial, one group received a minimally invasive treatment called carotid artery stenting along with intensive medical care, while another group received intensive medical care alone.
Carotid artery stenting involves placing a tiny metal tube called a stent inside the narrowed artery to hold it open and allow blood to flow more freely. This is done using a thin tube inserted through a blood vessel, usually in the groin, and guided up to the neck.
In the second trial, one group received traditional surgery called carotid endarterectomy along with medical care, while the other group again received medical care alone. In this surgery, a doctor opens the artery and physically removes the plaque.
All participants, no matter which group they were in, received careful and thorough medical treatment. This included medications and coaching to control blood pressure, lower harmful LDL cholesterol, manage diabetes, and stop smoking. Doctors closely monitored them and worked to reduce every possible risk factor for stroke.
When the researchers looked at the results, they found a clear difference between the two procedures. In the stenting group, only 2.8 percent of patients had a stroke on the same side as the narrowed artery over a four-year period.
In comparison, 6 percent of patients who received medical care alone had a stroke. This means the risk of stroke was cut by roughly half in those who received stents. This was a major and meaningful difference.
In contrast, the surgery group did not show the same clear benefit. Although the stroke rate was slightly lower for people who had surgery plus medical care compared to those who had medical care alone, the difference was not strong enough for scientists to be sure it was not due to chance.
Importantly, serious complications from both stenting and surgery were rare, showing that both procedures can be performed safely in experienced centers.
In reviewing and analyzing this study, the findings suggest a shift in how doctors may prevent strokes in people with severe carotid artery narrowing. The results show that stenting, when combined with modern medical treatment, can offer significant protection for certain patients, even if they have no symptoms.
At the same time, the study shows that not everyone needs an invasive procedure. Some people may do just as well with excellent medical care alone.
This research highlights the importance of personalized treatment. Factors such as the amount of narrowing, the shape and stability of the plaque, a person’s age, and their overall health may all play a role in deciding the best approach.
The researchers are continuing to study whether advanced imaging tools can help doctors better identify which patients will benefit most from stenting, surgery, or medical treatment alone.
Overall, the CREST-2 study brings clarity to a long-standing medical question. It confirms that modern medicine has greatly improved stroke prevention, but it also shows that a simple, minimally invasive procedure can provide extra protection for selected patients.
This balanced and careful approach gives both doctors and patients better information to make life-saving decisions.
If you care about stroke, please read studies that diets high in flavonoids could help reduce stroke risk, and MIND diet could slow down cognitive decline after stroke.
For more health information, please see recent studies about antioxidants that could help reduce the risk of dementia, and tea and coffee may help lower your risk of stroke, dementia.
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