A Columbia-led clinical trial published in JAMA on October 19, 2026, found that opening clogged carotid arteries via stenting or surgery fails to improve cognition. The CREST-H trial tracked 291 asymptomatic carotid stenosis patients over one year, finding no cognitive difference between revascularization and medication alone. Study leader Dr. Randolph Marshall noted that while stenting cuts stroke risk in CREST-2, revascularization cannot reverse cognitive decline.
CREST-H cognitive results
- ▪The CREST-H clinical trial demonstrated that opening carotid artery blockages through stenting or surgery to increase brain blood flow does not improve cognition compared to medication alone.
- ▪Cognitive scores improved slightly over one year in both CREST-H trial groups, showing no difference between patients receiving revascularization procedures and those treated with medication alone.
- ▪CREST-H leader Dr. Randolph Marshall and Columbia University researchers concluded revascularization cannot be expected to reverse cognitive decline in severe asymptomatic carotid stenosis, stating medical care must emphasize prevention.
CREST-H study design
- ▪The CREST-H clinical trial enrolled 291 patients with asymptomatic carotid stenosis of 70% or greater to measure cerebral blood flow and cognition at enrollment and one year later.
- ▪The CREST-H study was conducted as part of the larger CREST-2 clinical trial, which aimed to determine the best methods to prevent strokes in people with severe carotid artery blockages.
- ▪A Columbia University-led study called CREST-H, published in JAMA on October 19, 2026, evaluated whether opening severe carotid artery blockages improves cognitive function.
Hypothesis on blood flow and cognition
- ▪Dr. Randolph Marshall stated that until the CREST-H trial, the hypothesis that restoring cerebral blood flow with stenting or surgery could improve cognition had never been tested in a randomized clinical trial.
- ▪Prior to the CREST-H clinical trial, animal studies and case series had indicated that improving cerebral blood flow by opening carotid blockages might enhance cognition.
CREST-2 stroke risk findings
- ▪CREST-2 study co-designer Dr. Randolph Marshall stated that trial findings showing reduced stroke risk from stenting have already led to increased carotid stent usage in medical practice.
- ▪The CREST-2 clinical trial found that combining medication with stenting decreased strokes twofold compared to medication alone, whereas combining medication with blockage-removing surgery did not.
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