In November 2025, the New England Journal of Medicine published data from the Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Study (CREST-2) trial. This study sought to uncover new revascularization practices for managing stroke risk in patients with asymptomatic carotid stenosis (ACS), a condition that occurs when plaque narrows the carotid artery, increasing risk of stroke.
In a new byline published on MedCity News, Society for Vascular Surgery (SVS) President Dr. Keith Calligaro and SVS members Drs. Marc Schermerhorn and Ali AbuRahma collaborated to explain why this data has been polarizing within the clinical community and how it can inform, not replace, clinical judgement. The study, which included two separate, observer-blinded randomized controlled trials, investigated how revascularization can work alongside medical therapies in ACS patients at risk of stroke. However, the findings were presented in a way that suggest the two trials are comparative, despite using distinct patient populations and seeing unique outcomes. Such broad and inaccurate conclusions urge readers to reconsider established medical practice and treatment methods for ACS patients.
While CREST-2's findings are important in the broader ACS treatment landscape, they do not fully encapsulate the diverse patient population and dynamic treatment environment. SVS authors urge clinicians to see how CREST-2's findings are a milestone, not the final word.