Carotid stenting or surgery does not boost cognition, randomized trial finds
A Columbia-led randomized clinical trial found that opening severe carotid artery blockages with stenting or surgery did not improve cognition compared with medication alone. The CREST-H study enrolled 291 patients with asymptomatic carotid stenosis of 70% or greater and assessed cerebral blood flow and cognition at baseline and one year later. Although both groups showed slight cognitive improvements, there was no difference between them, according to results published in JAMA.
CREST-H was embedded within CREST-2, a multicenter effort comparing stroke-prevention strategies for severe carotid narrowing. In CREST-2, adding stenting to medication reduced strokes by about half relative to medication alone, while surgery did not show that benefit, according to the source material.
The randomized CREST-H analysis followed 291 people with asymptomatic carotid stenosis of at least 70%. Researchers measured cerebral blood flow and cognitive performance initially and after one year. Both treatment groups improved slightly, yet the procedure group and medication-only group did not differ. The authors concluded that revascularization should not be expected to reverse cognitive decline in this population, underscoring prevention.
For patients with symptomless severe carotid narrowing, these findings may temper expectations that stenting or surgery will sharpen thinking or memory. Clinicians could focus more on medication, risk-factor control, and prevention, while patients and families may weigh procedural risks differently. Because the trial was limited to 291 people with specific criteria, broader effects on practice and health systems remain uncertain. The results may also reinforce prevention and early management conversations, though they do not by themselves dictate individual care.