Heck Donald V, Roubin Gary S, Rosenfield Kenneth G, Gray William A, White Christopher J, Jovin Tudor G, Matsumura Jon S, Lal Brajesh K, Katzen Barry T, Dabus Guilherme, Jankowitz Brian T, Brott Thomas G
From the Novant Health Forsyth Comprehensive Stroke Center (D.V.H.), Winston Salem, NC; Cardiovascular Associates of the Southeast (G.S.R.), Birmingham, AL; Massachusetts General Hospital (K.G.R.), Boston; Main Line Health System/Lankenau Heart Institute (W.A.G.), Wynnewood, PA; Ochsner Medical Institutions (C.J.W.), New Orleans, LA; University of Pittsburgh Medical Center (T.G.J., B.T.J.), PA; University of Wisconsin School of Medicine and Public Health (J.S.M.), Madison; University of Maryland Medical Center (B.K.L.), Baltimore, MD; Miami Cardiac and Vascular Institute (B.T.K., G.D.); and Mayo Clinic (T.G.B.), Jacksonville, FL.
Neurology. 2017 May 23;88(21):2061-2065. doi: 10.1212/WNL.0000000000003956. Epub 2017 Apr 26.
Two positive randomized trials established carotid endarterectomy (CEA) as a superior treatment to medical management alone for the treatment of asymptomatic carotid artery stenosis. However, advances in medical therapy have led to an active and spirited debate about the best treatment for asymptomatic carotid stenosis. The Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis (CREST 2) trial aims to better define the best treatment for the average patient with severe asymptomatic carotid stenosis. Enrollment in the trial may be hampered by strong opinions on either side of the debate. It is important to realize that equipoise exists and that neither the old data on CEA nor the new data on optimal medical therapy provide a rigorous answer. The assumption that medical therapy has already been proven superior to revascularization procedures may hinder both enrollment in the trial and technical advancements in revascularization procedures.
两项阳性随机试验证实，对于无症状性颈动脉狭窄的治疗，颈动脉内膜切除术（CEA）优于单纯药物治疗。然而，药物治疗的进展引发了一场关于无症状性颈动脉狭窄最佳治疗方法的激烈且活跃的辩论。无症状性颈动脉狭窄的颈动脉血运重建与药物治疗（CREST 2）试验旨在更好地确定重度无症状性颈动脉狭窄普通患者的最佳治疗方法。该试验的入组可能会受到辩论双方强烈观点的阻碍。重要的是要认识到存在均衡状态，而且关于CEA的旧数据和关于最佳药物治疗的新数据都没有提供严格的答案。认为药物治疗已被证明优于血运重建手术的假设可能会阻碍试验入组以及血运重建手术的技术进步。
