CREST-H Clinical Trial on Carotid Stenosis and Cognition

A recent Columbia-led randomized clinical trial called CREST-H revealed that revascularization procedures, such as stenting or surgery to open severely narrowed carotid arteries, do not provide any additional cognitive benefits compared to medication alone over a one-year period. Researchers enrolled 291 patients with asymptomatic carotid stenosis of at least 70 percent, assessing their brain blood flow and cognition at enrollment and one year later. The study's lead researcher, Randolph Marshall, MD, noted that while animal studies and case series offered tantalizing clues that improving brain blood flow might reverse cognitive decline, the randomized clinical trial showed no significant cognitive difference between patients undergoing procedures and those receiving medication alone. Despite failing to boost cognitive function, the broader CREST-2 parent trial demonstrated that adding stenting to medication cuts stroke risk by about half for people with severe carotid blockages. This established a critical distinction between preventing strokes and reversing cognitive impairment through surgical intervention. The findings suggest that clinicians should not expect revascularization procedures to enhance thinking skills beyond what standard medication provides, emphasizing the ongoing importance of preventing carotid stenosis and relying on medical management for cognitive preservation.