CREST 2 Trial: Changing Practice or Raising Questions? with B. Rantner & C. Hicks

The publication of CREST-2 has reignited one of the longest-standing debates in vascular medicine: should asymptomatic carotid stenosis still be treated invasively in the era of modern best medical therapy? In this episode, Laurence Bertrand and Rosalinda D'Amico discuss the trial with Barbara Rantner and Caitlin Hicks, exploring its methodology, controversial findings, and the implications for the management of asymptomatic carotid stenosis.

Full name of guests:

Dr. Barbara Rantner – TUM University Hospital, Munich, Chair of ESVS and DGG guideline writing committee

Dr. Caitlin Hicks, Johns Hopkins University School of Medicine, Member of the writing committee ESVS and SVS guidelines

Shownotes:

Brott TG, Howard G, Lal BK, Voeks JH, Turan TN, Roubin GS, Lazar RM, Brown RD Jr, Huston J 3rd, Edwards LJ, Jones M, Clark WM, Chamorro Á, Llull L, Mena-Hurtado C, Heck D, Marshall RS, Howard VJ, Moore WS, Barrett KM, Demaerschalk BM, Sangha N, Aronow H, Foster M, Sternbergh WC 3rd, Shawl F, Lanzino G, Rapp J, Tran HS, Ecker R, Mackey A, Ali V, Given C 2nd, Teal P, Kashyap VS, Mukherjee D, Harrigan M, Silverman S, Koopmann M, Wadley VG, Zhang Y, Rhodes JD, Chaturvedi S, Meschia JF; CREST-2 Investigators. Medical Management and Revascularization for Asymptomatic Carotid Stenosis. N Engl J Med. 2026 Jan 15;394(3):219-231. doi: 10.1056/NEJMoa2508800. Epub 2025 Nov 21. PMID: 41269206; PMCID: PMC13148431.

Halliday A, Bulbulia R, Bonati LH, Chester J, Cradduck-Bamford A, Peto R, Pan H; ACST-2 Collaborative Group. Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy. Lancet. 2021 Sep 18;398(10305):1065-1073. doi: 10.1016/S0140-6736(21)01910-3. Epub 2021 Aug 29. PMID: 34469763; PMCID: PMC8473558.