January 2026 | Issue 109
www.vascularnews.com
14 Late-breaking data Highlights from key autumn conferences
Featured in this issue:
3 SWHSI-2
Vascular Society president weighs in
10 Profile
Marianne Brodmann
12 Radiation safety Patrick Muck examines new tech
Brajesh K Lal presents CREST-2 data at VEITH 2025
CREST-2: Landmark trial shows reduced stroke risk with carotid stenting versus medical therapy alone The US National Institutes of Health (NIH)-funded CREST-2 study has found that, for people with high-grade asymptomatic carotid artery stenosis who have not experienced recent stroke symptoms, a carotid artery stenting (CAS) procedure—combined with intensive medical therapy—significantly lowered stroke and death rates compared with medical therapy alone. However, the more traditional “gold standard” approach of carotid endarterectomy (CEA) did not show the same benefit.
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US FDA approves Gore stent following positive data
STORM-PE finds mechanical thrombectomy superior to anticoagulation alone
CREST-2
hese first “game-changing” results outlining four-year outcomes were presented at the 2025 VEITHsymposium (18–22 November, New York, USA) by CREST-2 co-principal investigator (PI) Brajesh K Lal (University of Maryland, Baltimore, USA). Earlier the same day, the data were delivered at the 2025 Society of Vascular and Interventional Neurology (SVIN) annual meeting (19–22 November, Orlando, USA) by James Meschia (Mayo Clinic, Jacksonville, USA). The trial results were also published in the New England Journal of Medicine. Lal outlined how the study’s two simultaneously running randomised controlled trials (RCTs) comparing CAS plus medical therapy to medical management alone, and CEA plus medical therapy to medical management alone, enrolled 2,485 patients from 155 sites across five countries. In the CAS trial, stroke and death rates out to four years were 6% in patients who were assigned medical management and 2.8% when CAS was added, Lal told VEITH 2025. “The absolute risk difference of 3.2% in favour of CAS was statistically significant,” he said. In the CEA trial, stroke and death out to four years was 5.3% in the medical therapy group and 3.7% when CEA was added, Lal continued. “The absolute risk difference was still in favour of CEA; however, it did not reach significance.”
16 IVC stenting
Lal explained: “The patterns of differences in the CAS and CEA trials were mirrored in the 44-day periprocedural period; however, in the post-procedural period starting 45 days out to four years, both CAS and CEA performed better in terms of preventing stroke and death compared to their respective medical management groups.” Concluding, Lal emphasised how the absolute difference favouring CAS was significant, noting “31 people with highgrade asymptomatic carotid stenosis needed to be treated to prevent a primary event at four years in the trial”. Thomas Brott (Mayo Clinic College of Medicine, Jacksonville, USA), co-PI, followed Lal at the VEITH 2025 podium to tackle whether the CREST-2 evidence is conclusive
In one generation, since ACAS, we’ve gone from medical risk of 11% to a risk of 6%, which is remarkable.” Thomas Brott
THE USE OF MECHANICAL thrombectomy, specifically computerassisted vacuum thrombectomy (CAVT) using the 16Fr Lightning Flash system (Penumbra), with anticoagulation achieves superior reduction in right heart strain compared to anticoagulation therapy alone in patients with acute intermediate-high-risk pulmonary embolism (PE). This is according to data recently published in Circulation from the STORM-PE randomised controlled trial (RCT). “These findings mark a pivotal step in advancing care for PE, providing the strongest evidence to date that advanced therapy with CAVT can rapidly and safely improve recovery of the right heart compared to conventional anticoagulation therapy,” said co-global principal investigator (PI) Robert Lookstein (Icahn School of Medicine at Mount Sinai, New York, USA) in a press release announcing the results. Lookstein had presented the data for the first time at the 2025 Transcatheter Cardiovascular Therapeutics (TCT) conference (25– 28 October, San Francisco, USA). “STORM-PE supports the role of CAVT as a more effective therapeutic option for intermediate-high-risk patients and will evolve the paradigm of care by delivering rapid relief with a comparable safety profile to anticoagulation alone,” Lookstein continued. The trial enrolled 100 patients across 22 international sites. Patients treated with CAVT demonstrated a greater reduction in right-to-left ventricular (RV/LV) diameter ratio within 48 hours (mean reduction 0.52 vs. 0.24; p<0.001) and nearly 80% of patients had positive treatment effect with CAVT, which was significantly greater than the patients who Continued on page 5
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