Rationale, Design, and Implementation of Intensive Risk Factor Treatment in the CREST2 Trial

Abstract

A subanalysis of patients entered in the CREST2 trial (carotid revascularization and medical management for asymptomatic carotid stenosis) from 2014 to March 23, 2020 was performed. Interim risk factor data were gathered for 1618 patients at baseline and follow-up through 24 months analyzing intensive medical management alone compared with intensive medical management plus carotid endarterectomy or transfemoral carotid artery stenting for preventing stroke or death. The mean baseline low-density lipoprotein level was 80 mg/dL, which had significantly improved to 67 mg/dL after intensive medical treatment. The mean baseline systolic blood pressure of 140 mm Hg had significantly improved to 130 mm Hg. A rigorous approach to intensive stroke risk factor management in CREST2 resulted in significant improvements in risk factor control.