Mayo Clinic Study Finds Stenting Lowers Stroke Risk in Patients With Carotid Artery Narrowing
A major international study led by researchers at Mayo Clinic has identified an effective strategy to reduce the risk of stroke in people with severe carotid artery narrowing who have not recently experienced stroke symptoms. The research found that a minimally invasive carotid artery stenting procedure, when combined with intensive medical therapy, significantly lowered the risk of stroke compared to medical therapy alone.
Funded by the National Institutes of Health (NIH) and published in The New England Journal of Medicine, the findings come from the CREST-2 trial (Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis)—the largest study to date comparing modern treatment approaches for this condition. Carotid artery stenosis is caused by plaque buildup in the arteries that supply blood to the brain and can lead to stroke if blood flow becomes blocked.
For many years, both carotid endarterectomy—a traditional surgical procedure—and stenting have been used to treat this condition. However, advances in medications and improved control of cardiovascular risk factors raised questions about whether these procedures were still necessary for patients without symptoms.
“Decades ago, surgery clearly helped prevent strokes in many patients,” said Dr. Thomas Brott, senior author of the study and a neurologist at Mayo Clinic in Florida. “But medical therapy has improved so much that we needed to reassess the balance of benefit and risk for people without symptoms.”
The CREST-2 program consisted of two parallel randomized clinical trials conducted across 155 medical centers in five countries, including the United States, Canada, Spain, Israel, and Australia. More than 2,400 adults with at least 70% carotid artery narrowing and no recent history of stroke or transient ischemic attack participated.
One trial compared carotid stenting plus intensive medical therapy with medical therapy alone. The second trial compared carotid endarterectomy plus medical therapy with medical therapy alone. All participants received comprehensive medical care, including lifestyle counseling and medications to control blood pressure, LDL cholesterol, diabetes, and smoking.
After four years of follow-up, researchers found that 2.8% of patients who received stenting plus medical therapy experienced a stroke, compared with 6% of those treated with medical therapy alone, representing nearly a 50% reduction in stroke risk. In contrast, the surgical group did not show a statistically significant benefit over medical therapy alone. Serious complications were uncommon in both procedures.
Experts emphasize that the results support a personalized approach to care. While some patients may benefit from stenting, others may achieve sufficient protection with medical therapy alone. Researchers will continue long-term monitoring and explore whether advanced imaging can help determine which patients are most likely to benefit from each treatment option.
These findings provide clearer guidance for physicians and patients, marking an important step forward in the prevention of stroke.
