Study finds carotid stenting significantly reduces stroke risk

The study was published in the New England Journal of Medicine

NEW ORLEANS – A landmark study published in the New England Journal of Medicine shows that for people with severe narrowing of the carotid artery who have not had recent symptoms, a stenting procedure combined with strong medical treatment can lower the chance of stroke or death in patients with appropriate anatomy for this kind of stenting. This narrowing in the artery – high-grade stenosis – can be very serious, but using stents plus proper medication and care helped patients live healthier lives. 

W. Charles Sternbergh III, MD, DFSVS, FACS, system chair of vascular services and vice chair of the department of surgery for Ochsner Health, was a co-author of the study.

Study Overview

The CREST-2 study included two large trials looking for the best way to prevent strokes in people with severe, but symptom-free, narrowing of their neck arteries, or carotid stenosis. Researchers compared three groups:

• People who received strong medical treatment only

• People who had a stenting procedure plus strong medical treatment

• People who had surgery to remove the blockage (endarterectomy) plus strong medical treatment

Ochsner began recruiting patients for this trial in 2014 and was in the top 10 recruiting sites out of 155 worldwide.   

Key Findings

• Carotid stenting with strong medical care lowered the risk of stroke or death more than medical care alone in patients with favorable anatomy for this procedure

• Carotid surgery (endarterectomy) did not show a bigger benefit over medical care alone for these patients.

• The study’s results help doctors and patients decide on the safest, most effective way to protect against strokes.

The study found that people who received a stent and strong medical care were less likely to have a stroke or die within four years compared to those who had only medical treatment. On the other hand, a type of surgery to remove the blockage, endarterectomy, did not show a clear extra benefit over medical care alone for these patients.

"These results demonstrate that intervention on severe asymptomatic carotid stenosis can significantly reduce the long-term risk of stroke when performed in patients with favorable anatomy. said Dr. Sternbergh. “However, prudent anatomic patient selection is critical.  The study confirms that for the right patients, a minimally invasive stenting procedure is a powerful tool to prevent future strokes. It reinforces the importance of a personalized approach, combining advanced procedures with dedicated medical management to achieve the best possible outcomes for our community.

This research provides clear, actionable evidence that helps physicians and patients make more informed decisions. It highlights the effectiveness of a proactive, tailored treatment plan that includes anatomic-specific patient selection, advanced intervention and rigorous management of risk factors like high blood pressure and cholesterol. The study also underscores the need for patients to be aware of stroke symptoms and seek immediate care if they occur.