Jose “Pepe” Alvarez Jr., M.D., Memorial Lecture on Vascular Disease: CREST-2 Trial Results and Carotid Therapy

The management of carotid artery disease is rapidly evolving, with new evidence and advances in therapy reshaping how clinicians approach treatment decisions. Findings from the CREST-2 trial, along with improvements in medical management and revascularization techniques, are redefining the roles of carotid artery stenting, carotid endarterectomy and optimal medical management, emphasizing the importance of individualized, evidence-based care.

In this online course, James F. Meschia, M.D.,, Professor of Neurology and Chair Emeritus at the Mayo Clinic, presents Modern Approaches to Managing Carotid Disease. This activity will provide a practical, evidence-based update on carotid therapy and equip clinicians with strategies to apply current data, optimize patient selection and enhance clinical decision making in everyday practice.

Target Audience

Cardiologists, Vascular Surgeons, Interventional Radiologists, Interventional Cardiologists, Pharmacists, Pharmacy Technicians, Primary Care Physicians, Podiatrists, Emergency Medicine Physicians, General Internists, Nurses, Respiratory Therapists and other interested healthcare providers.

Learning Objectives

  • Evaluate current evidence, including findings from the CREST-2 trial, in the management of asymptomatic carotid artery stenosis 
  • Compare the risks, benefits and indications of intensive medical therapy, carotid artery stenting and carotid endarterectomy 
  • Apply patient-specific factors to guide evidence-based treatment selection for carotid artery disease
Additional information
Bibliography: 
  • American Heart Association (2022). Life's Essential 8 [Infographic]. American Heart Association.
  • Brott, T. G., Howard, G., Lal, B. K., Voeks, J. H., Turan, T. N., Roubin, G. S., ... & Meschia, J. F. (2026). Medical management and revascularization for asymptomatic carotid stenosis. New England Journal of Medicine, 394(3), 219-231.
  • Bushnell, C., Kernan, W. N., Sharrief, A. Z., Chaturvedi, S., Cole, J. W., Cornwell, W. K., III, ... Whelton, P. K. (2024). 2024 guideline for the primary prevention of stroke: A guideline from the American Heart Association/American Stroke Association. Stroke, 55(12), e344-e424. 
  • Cheng, S. F., van Velzen, T. J., Gregson, J., Richards, T., Jäger, H. R., Simister, R., ... Bonati, L. H. (2022). The 2nd European Carotid Surgery Trial (ECST-2): Rationale and protocol for a randomised clinical trial comparing immediate revascularisation versus optimised medical therapy alone in patients with symptomatic and asymptomatic carotid stenosis at low to intermediate risk of stroke. Trials, 23, Article 606. 
  • Chimowitz, M. I. (2026). Design matters: How methodological decisions may have shaped the findings of CREST-2. Stroke, 57(5), 1476-1480. 
  • Donners, S. J. A., van Velzen, T. J., Cheng, S. F., Gregson, J., Hazewinkel, A. D., Pizzini, F. B., ... Bonati, L. H. (2025). Optimised medical therapy alone versus optimised medical therapy plus revascularisation for asymptomatic or low-to-intermediate risk symptomatic carotid stenosis (ECST-2): 2-year interim results of a multicentre randomised trial. The Lancet Neurology, 24(5), 389-399.
  • Lal, B. K., Roubin, G. S., Meschia, J. F., Jones, M., Heck, D. V., Sternbergh III, W. C., ... & Brott, T. G. (2025). Carotid artery stenting with open vs closed stent cell configurations in the CREST-2 Registry. Journal of vascular surgery, 82(1), 127-135.
  • Meschia, J. F., Lal, B., & Brott, T. (2026, February). CREST-2: Early Reflections on the Primary Results. In Seminars in Vascular Surgery. WB Saunders.
  • McGurgan, I. J., Kelly, P. J., Turan, T. N., & Rothwell, P. M. (2022). Long-term secondary prevention: Management of blood pressure after a transient ischemic attack or stroke. Stroke, 53(4), 1085-1103.
  • Song, P., Fang, Z., Wang, H., Cai, Y., Rahimi, K., Zhu, Y., Fowkes, F. G. R., Fowkes, F. J. I., & Rudan, I. (2020). Global and regional prevalence, burden, and risk factors for carotid atherosclerosis: A systematic review, meta-analysis, and modelling study. The Lancet Global Health, 8(5), e721-e729.
     

Course Summary

Available credit: 
  • 1.50 ABIM Medical Knowledge
  • 1.50 ABS Accredited CME
  • 1.50 ABTS Accredited CME
  • 1.50 AMA PRA Category 1 Credit™
  • 1.50 General certificate of attendance
  • 1.50 Nurse Practitioners
  • 1.50 Florida Board of Nursing
  • 1.50 Florida Board of Pharmacy
  • 1.50 Florida Board of Podiatric Medicine
  • 1.50 Florida Board of Respiratory Therapy
Course opens: 
08/07/2026
Course expires: 
08/06/2029

Faculty

James F. Meschia, M.D.
Consultant, Department of Neurology
Frances Bartlett Kinne, Ph.D., Professor
Mayo Clinic Enterprise Personnel Committee Chair
Mayo Clinic Florida
Jacksonville, Florida

James F. Meschia, M.D., faculty for this educational activity, receives in-kind research support from Regeneron Pharmaceuticals, Inc., and has indicated that the presentation or discussion will not include off-label or unapproved product usage.

The following non-faculty contributors involved in the planning, development and editing/review of the content have relevant financial relationships to disclose with ineligible companies*:

  • Barry T. Katzen, M.D. – Advisor for Philips, Gore and Boston Scientific. 
  • Howard Katzman, M.D. has nothing to disclose
  • Ignacio Rua, M.D., has nothing to disclose.
  • Cristina Alvarez has nothing to disclose.

All financial relationships have been mitigated.

Others involved in the planning, development and editing/review of the content have no relevant financial relationships to disclose with ineligible companies. * 

*Ineligible companies - Companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Artificial Intelligence (AI) Use Disclosure

For this activity, AI was used to assist in developing and refining assessment questions and learner feedback based on medical writer-authored content, and to help align assessments with competency-level outcome measures consistent with ACCME standards. All AI-assisted content received subject matter expert review, validation, and approval before use.

 

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Baptist Health South Florida is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Baptist Health has been re-surveyed by the ACCME and awarded Commendation for 6 years as a provider of CME for physicians.

Baptist Health South Florida designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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American Board of Surgery - Maintenance of Certification (MOC) - Accredited CME - General Surgery

Successful completion of this CME activity, which includes participation in the evaluation component, enables the learner to earn credit toward the CME of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.

Your participation information will be shared with specialty boards through the ACCME's PARS reporting system. Successful completion of a course examination is required. Submissions are recorded in approximately 48 hours. You will receive an email when your credits have been processed.

 

American Board of Internal Medicine Maintenance of Certification

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.5 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

Your participation information will be shared with specialty boards through the ACCME's PARS reporting system. Successful completion of a course examination is required. Submissions are recorded in approximately 48 hours. You will receive an email when your credits have been processed.

Through an agreement between the Accreditation Council for Continuing Medical Education and the Royal College of Physicians and Surgeons of Canada, medical practitioners participating in the Royal College MOC Program may record completion of accredited activities registered under the ACCME’s “CME in Support of MOC” program in Section 3 of the Royal College’s MOC Program.

American Board of Thoracic Surgery - Maintenance of Certification (MOC) - Accredited CME

Successful completion of this CME activity, which includes participation in the evaluation component, enables the learner to earn credit toward the CME of the American Board of Thoracic Surgery’s Continuing Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABTS credit.

 

Available Credit

  • 1.50 ABIM Medical Knowledge
  • 1.50 ABS Accredited CME
  • 1.50 ABTS Accredited CME
  • 1.50 AMA PRA Category 1 Credit™
  • 1.50 General certificate of attendance
  • 1.50 Nurse Practitioners
  • 1.50 Florida Board of Nursing
  • 1.50 Florida Board of Pharmacy
  • 1.50 Florida Board of Podiatric Medicine
  • 1.50 Florida Board of Respiratory Therapy
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