Does a patient’s ability to get risk factors under control influence your recommendation for surgical vs. medical management of asymptomatic carotid disease?

No, because in CREST-2, stenting was better than medical therapy for stroke prevention in patients with >70% asymptomatic carotid stenosis. I would, however, still want such patients to aggressively control their vascular risk factors.

Controlling risk factors is paramount, regardless of medical versus surgical management. For asymptomatic disease, primary prevention is the goal, as opposed to the secondary prevention measures we commonly reference.

Since CREST-2 was published in late 2025, there has been a lot of discussion on how...