Groundbreaking Global Trial Redefines Stroke Prevention for High-Risk Patients

DETROIT — A major study could change how care teams prevent strokes in patients who show no symptoms but face serious risk.  

Henry Ford Health played a key role in the research, which was published in the New England Journal of Medicine—widely regarded as the world’s most prestigious medical journal. Dr. Herb Aronow, Medical Director of Henry Ford Health’s Heart and Vascular Services, is a co-author of the report on the CREST-2 trial, which took place in 155 health centers in five countries. 

“Every year, about 800,000 strokes occur in the U.S., and most are caused by insufficient blood flow to the brain. Blockages in the carotid arteries account for roughly one in six of these cases,” Aronow said. “Preventing stroke starts with healthy habits, medications, and, when needed, procedures to clear carotid blockages. When prevention isn’t possible, fast access to stroke care is critical to protect brain function and improve recovery.” 

The study found that for patients with asymptomatic severe carotid artery stenosis—a dangerous narrowing of the artery that supplies blood to the brain—carotid artery stenting, plus medical therapy, reduced the risk of stroke, more than medical therapy alone, but the same was not observed for carotid endarterectomy, a traditional surgery to address these blockages. 

Researchers compared outcomes between medical therapy with versus without two established treatments for restoring blood flow in the carotid artery. Stenting uses a catheter to place a small mesh tube inside the artery to prop it open. Endarterectomy relies on open surgery to physically remove the plaque. The CREST-2 trial showed that stenting but not endarterectomy was superior to medicine alone for this specific patient group. 

Asymptomatic carotid artery blockages can sometimes be detected during a physical exam with a stethoscope, and imaging tests such as ultrasound, CT scans, or MRI can confirm their presence. 

Millions of people have severe narrowing in this major artery to the brain and don’t know it, because the first warning sign can be a life-threatening stroke. For many of these patients, this study suggests a minimally invasive procedure may protect them more than medicine alone. 

“The CREST-2 trial showed that for patients with severe carotid stenosis who have no symptoms, carotid stenting can significantly lower the risk of future stroke,” Aronow said. “At Henry Ford Health, our multidisciplinary team of cardiovascular specialists performs carotid stenting and offers a full range of treatments to help reduce stroke risk for this vulnerable population.” 

Henry Ford Health was one of the participating sites in the multicenter trial, which is considered one of the most important investigations in stroke prevention in recent years. 

Aronow was a site principal investigator for the study at two other hospitals before joining the team at Henry Ford Hospital in Detroit.

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