Approximately 5-10% of strokes are caused by narrowing of the carotid artery. Surgery and stenting are used to reduce the narrowing of these arteries and restore normal blood flow. With seniors living longer, differences in the long-term benefits of these procedures would play a major role in treatment choice. Results from the 10-year CREST study (Carotid Revascularization Endarterectomy versus Stenting Trial) were published this week in the New England Journal of Medicine. This study, one of the largest of its kind, showed that stenting and surgery are equally effective at lowering the long-term risk of stroke (~7% for both procedures). These benefits were seen regardless of patient age or gender. The question of how to best manage asymptomatic patients (patients whose carotid artery has narrowed but they have not yet suffered symptoms), remains less clear. For example, should asymptomatic patients be managed with medical therapy alone or with a procedure? The ongoing CREST-2 trial will address this question. Here investigators are comparing medical therapy alone to surgery and stenting (plus medical therapy) for the prevention of stroke in asymptomatic patients. With the results of CREST-2 physicians should have a more complete picture on how to manage stroke risk in patients with narrowed carotid arteries.