The CREST-2 study results are here!
Click here to read them in the
New England Journal of Medicine!
155 CREST-2 Centers
enrolled 2,485 participants!
To view a video description of the CREST-2 study by Thomas G. Brott, MD, Principal Investigator,
click the play arrow on the image below.
click the play arrow on the image below.
Who participated in CREST-2?
Men and women who:
Men and women who:
- Were 35 years and older
- Had narrowing (70% or greater) of at least one of their carotid arteries
- Lacked other serious medical complications
What was CREST-2?
CREST-2 was a study for people who have narrowing of their carotid artery, without stroke warning signs caused by that artery such as mini-strokes, temporary strokes called TIAs, temporary paralysis or numbness on one side of the body, temporary slurring of speech, or other temporary brain symptoms.
What was the purpose of CREST-2?
CREST-2 was designed to compare three different methods of stroke prevention to find the safest and most effective treatment. The stroke prevention methods included intensive medical management alone compared to intensive medical management in combination with a procedure to reopen the carotid artery in your neck (called revascularization) for treatment of plaque buildup. The two procedures available in this trial were carotid endarterectomy (en-dar-ter-EK-ta-mee) and carotid stenting. All study participants received intensive medical management to help control their risk factors for stroke.
Why CREST-2?
CREST-2 physicians want to find the best way to prevent strokes. Over the past 20 years, medical management of stroke risk factors has improved such that risk of stroke from asymptomatic carotid stenosis has been significantly reduced. Carotid endarterectomy and carotid artery stenting (both revascularization procedures) have also improved. To date, no research has been conducted to compare the treatment differences between 21st century medical management and these two procedures.
CREST-2 was intended to compare the two procedures to intensive medical management with drugs and lifestyle modification in patients without recent stroke and without stroke warning signs. The information from this study will help us learn the best way to prevent strokes in other people like you.
CREST-2 was a study for people who have narrowing of their carotid artery, without stroke warning signs caused by that artery such as mini-strokes, temporary strokes called TIAs, temporary paralysis or numbness on one side of the body, temporary slurring of speech, or other temporary brain symptoms.
What was the purpose of CREST-2?
CREST-2 was designed to compare three different methods of stroke prevention to find the safest and most effective treatment. The stroke prevention methods included intensive medical management alone compared to intensive medical management in combination with a procedure to reopen the carotid artery in your neck (called revascularization) for treatment of plaque buildup. The two procedures available in this trial were carotid endarterectomy (en-dar-ter-EK-ta-mee) and carotid stenting. All study participants received intensive medical management to help control their risk factors for stroke.
Why CREST-2?
CREST-2 physicians want to find the best way to prevent strokes. Over the past 20 years, medical management of stroke risk factors has improved such that risk of stroke from asymptomatic carotid stenosis has been significantly reduced. Carotid endarterectomy and carotid artery stenting (both revascularization procedures) have also improved. To date, no research has been conducted to compare the treatment differences between 21st century medical management and these two procedures.
CREST-2 was intended to compare the two procedures to intensive medical management with drugs and lifestyle modification in patients without recent stroke and without stroke warning signs. The information from this study will help us learn the best way to prevent strokes in other people like you.
What three methods for stroke prevention were studied?
Method 1
Intensive medical management using aspirin to prevent blood clot formation, medications to reduce blood pressure and bad cholesterol ("LDL-cholesterol"), and management of lifestyle risk factors such as physical activity, weight loss, and alcohol and tobacco use to prevent stroke. |
Method 2
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Method 3
Intensive medical management, as described in method 1, in combination with a procedure called carotid artery stenting. This procedure involves surgically threading a guide through a blood vessel to place a small mesh cage—a stent—inside the vessel to push vessel walls open and hold them there so blood flows unobstructed to prevent stroke. |
Illustrated process of how plaque builds up in your carotid arteries
Watch the video below to hear from a CREST-2 graduated patient what it was like to be a part of the trial!
Stay tuned for the CREST-H results published in February 2026!
A blockage in the carotid arteries can lower blood flow to the brain, which may affect memory or thinking in some people. But this condition may be treatable, either with medicine or with a stent or endarterectomy. CREST-H, a companion study to CREST-2, investigated this possibility among CREST-2 participants.
Those who are randomized into CREST-2 were asked if they would also like to participate in CREST-H. CREST-H participants received an MRI or CT scan of the brain’s blood flow free of charge. Reimbursement was provided at the time of the visit to help cover the cost of the visit. Some participants were asked to return for a follow-up scan one year later.
Those who are randomized into CREST-2 were asked if they would also like to participate in CREST-H. CREST-H participants received an MRI or CT scan of the brain’s blood flow free of charge. Reimbursement was provided at the time of the visit to help cover the cost of the visit. Some participants were asked to return for a follow-up scan one year later.
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