{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T08:56:56Z","timestamp":1793350616698,"version":"4.5.0"},"reference-count":40,"publisher":"American Medical Association (AMA)","issue":"16","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2026,10,27]]},"abstract":"\n Importance<\/jats:title>\n Studies show that asymptomatic carotid artery stenosis is associated with diminished cognition. Whether carotid revascularization leads to cognitive improvement is unclear.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine whether carotid revascularization improves cognition.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n Prespecified cognitive secondary outcomes of the CREST-2 randomized clinical trials of patients 35 years or older with 70% or greater asymptomatic carotid stenosis. Enrollment was December 2014 through July 2024, and follow-up ended July 2025. Five cognitive tests were administered before treatment and annually up to 4 years. Cognitive performances from 146 clinical sites were centrally assessed by telephone, blinded to treatment.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Two trials compared carotid stenting plus intensive medical management (CAS\u2009+\u2009IMM) with IMM alone and carotid endarterectomy plus IMM (CEA\u2009+\u2009IMM) with IMM alone.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n \n Five cognitive tests, assessing learning, memory, executive function, attention, and processing speed, administered to all patients, were assessed for unadjusted and adjusted mean\n z<\/jats:italic>\n scores using a linear mixed model. The minimal clinically important difference was 0.50 SD between treatment groups. The prespecified primary analysis was the fully adjusted composite\n z<\/jats:italic>\n score at 4 years. Secondary analyses assessed the individual tests and at the test intervals.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 2366 US study patients, 2165 (91.5%) participated in cognitive assessments, 1078 in the CAS trial (529 CAS\u2009+\u2009IMM; 549 IMM alone) and 1087 in the CEA trial (543 CEA\u2009+\u2009IMM; 544 IMM alone); mean age was 70.1 years (SD, 7.7) and 37.8% were female. Following baseline, 4954 test batteries were administered for a mean of 2.24 (SD, 1.09) follow-up years. There were no treatment-related differences in the fully adjusted estimated composite\n z<\/jats:italic>\n scores at 4 years for either the CAS trial (CAS\u2009+\u2009IMM, 0.22 [95% CI, 0.13 to 0.30] vs IMM alone, 0.18 [95% CI, 0.09 to 0.27]; between-group difference, 0.03 [95% CI, \u22120.09 to 0.15]) or the CEA trial (CEA\u2009+\u2009IMM, 0.25 [95% CI, 0.17 to 0.33] vs IMM, 0.23 [95% CI, 0.15 to 0.32]; between-group difference, 0.02 [95% CI, \u22120.09 to 0.14]). There were no significant differences between revascularization plus medical management vs IMM alone for any individual cognitive test.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In patients with severe asymptomatic carotid artery stenosis, revascularization with either CAS or CEA plus IMM, compared with IMM alone, did not significantly improve cognitive function at up to 4 years of follow-up.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2026.14703","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T15:01:40Z","timestamp":1789570900000},"page":"1425","source":"Crossref","is-referenced-by-count":4,"title":["Revascularization of Asymptomatic Carotid Artery Stenosis"],"prefix":"10.1001","volume":"336","author":[{"given":"Ronald M.","family":"Lazar","sequence":"first","affiliation":[{"name":"University of Alabama at Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James 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