Assessing the Cognitive Impact of Revascularization in Asymptomatic Carotid Disease: Ronald M. Lazar, PhD, FAHA

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"The data show that prior to revascularization there is cognitive decline beforehand, presumably as a result of flow failure across the stenosis. The notion is that, based on the work in stroke, where reperfusion therapy results in significant improvement in neurologic function, revascularization might not only reduce the risk of stroke in these individuals but improve cognition as well."

Carotid artery stenosis, a narrowing of the neck’s carotid arteries typically caused by plaque buildup, is generally managed with intensive medical therapy, including antiplatelet agents, medications for blood pressure or cholesterol control, and lifestyle modifications. Findings from an analysis of the CREST-2 trial (NCT02089217) presented at the recently concludedInternational Stroke Conference (ISC) 2026, held February 4-6, 2026, in New Orleans, Louisiana, showed that improving blood flow to the brain by opening a narrowed artery may not improve cognitive function in patients with severe carotid stenosis.¹

The study evaluated stroke rates in patients randomly assigned to intensive medical management alone, intensive medical management with carotid endarterectomy, or intensive medical management with stenting. A substudy of the CREST-2 trial used a “cognitive core” to measure cognitive performance from baseline for up to 4 years. Overall, findings demonstrated no differences in cognitive outcomes between participants who underwent revascularization and those receiving medical therapy alone. Notably, cognitive decline occurred only in patients who experienced a stroke, supporting the sensitivity of the cognitive assessments to neurologic changes.

To dive deeper into the results of this late-breaking presentation, lead author Ronald M. Lazar, PhD, FAHA, a professor of neurology and neurobiology at the University of Alabama at Birmingham, spoke with NeurologyLive^® during ISC 2026. In the interview, Lazar noted that the study used a structured, longitudinal approach to assess cognitive function over time. He explained that the findings highlighted key considerations regarding cognitive performance and the impact of different treatment strategies, as well as the relationship between vascular events and changes in brain function.

Click here for more coverage of ISC 2026.

REFERENCES
1. Lazar RM, Meschia JF, Edwards LJ, et al. The effect of treatment on cognitive function in patients with asymptomatic carotid artery stenosis: the CREST-2 Trial. Presented at: International Stroke Conference 2026; February 4-6, 2026; New Orleans, LA. Abstract LB003.
2. Improving blood flow to the brain in arteries with plaque did not improve cognitive skills. News release. American Stroke Association. February 4, 2026. Accessed February 4, 2026. https://newsroom.heart.org/news/improving-blood-flow-to-the-brain-in-arteries-with-plaque-did-not-improve-cognitive-skills