6533b828fe1ef96bd12883e9

RESEARCH PRODUCT

Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy.

Alison HallidayRichard BulbuliaLeo H BonatiJohanna ChesterAndrea Cradduck-bamfordRichard PetoHongchao PanAlison HallidayRichard BulbuliaLeo H BonatiRichard PetoHongchao PanJohn PotterHans Henning EcksteinBarbara FarrellMarcus FlatherAveril MansfieldBoby MihaylovaKazim RahimiDavid SimpsonDafydd ThomasPeter SandercockRichard GrayAndrew MolyneuxCliff P ShearmanPeter RothwellAnna BelliWill HerringtonParminder JudgePeter LeopoldMarion MafhamMichael GoughPiergiorgio CaoSumaira MacdonaldVasha BariClive BerryS BradshawWojciech BrudloAlison ClarkeJohanna ChesterRobin CoxAndrea Cradduck-bamfordSusan FathersKamran GabaMo GrayElizabeth HayterConstance HollidayRijo KurienMichael LaySteffi Le ConteJessica McmanusZahra MadgwickDylan MorrisAndrew MundaySandra PickworthWiktor OstaszMichiel PoorthuisSue RichardsLouisa TeixeiraSergey TochlinLynda TullyCarol WallisMonique WilletAlan YoungRenato CasanaChiara MalloggiAndrea Odero JrVincenzo SilaniGianfranco ParatiGiuseppe MalchiodiGiovanni MalferrariFrancesco StrozziNicola TusiniEnrico VecchiatiGioacchino CoppiAntonio LauricellaRoberto MorattoRoberto SilingardiJessica VeronesiAndrea ZiniEmanuele FerreroMichelangelo FerriAndrea GaggianoCarmelo LabateFranco NessiDaniele PsacharopuloAndrea ViazzoGiovanni MalacridaDaniela MazzaccaroGiovanni MeolaAlfredo ModafferiGiovanni NanoMaria Teresa OcchiutoPaolo RighiniSilvia StegherStefano ChiarandiniFilippo GriselliSandro LepidiFabio Pozzi MucelliMarcello NaccaratoMario D'oriaBarbara ZianiAndrea StellaMortalla DiengGianluca FaggioliMauro GargiuloSergio PalermoRodolfo PiniGiovanni Maria PudduAndrea VacircaDomenico AngilettaClaudio DesantisDavide MarinazzoGiovanni MastrangeloGuido ReginaRaffaele PulliPaolo BianchiLea CireniElisabetta CoppiRocco PizzirussoFilippo ScaliseGiovanni SorropagoValerio TolvaValeria CasoEnrico CieriPaola DerangoLuca FarchioniGiacomo IserniaMassimo LentiGian Battista ParlaniGuglielmo PupoGrazia PulaGioele SimonteFabio VerziniFederico CarimatiMaria Luisa 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IiiPavel BuchvaldLadislav EndrychMiroslav ŠErclWalter Campos JrIvan B CasellaNelson De LucciaAndré E V EstenssoroCalógero PrestiPedro Puech-leãoCelso R B NevesErasmo S Da SilvaCid J Sitrângulo JrJosé A T MonteiroGisela TinoneMarcelo Bellini DalioEdwaldo E JovilianoOctávio M Pontes NetoMauricio Serra RibeiroPatrick CrasJeroen M H HendriksMieke HoppenbrouwersPatrick LauwersCaroline LoosLaetitia YperzeeleMia GeenensDimitri HemelsoetIsabelle Van HerzeeleFrank VermassenParla AstarciFrank HammerValérie LacroixAndré PeetersRobert VerhelstSilvana CirelliPol DormalAnnelies GrimonprezBart LambrechtPhilipe LerutEddy ThuesGuy De KosterQuentin DesironAlain Maertens De NoordhoutDanielle MalmendierMireille MassozGeorges SaadMarc BosiersJoren CallaertKoen DelooseEstrella Blanco CañibanoBeatriz García FresnilloMercedes Guerra RequenaPilar C Morata BarradoMiguel Muela MéndezAntonio Yusta IzquierdoFernando Aparici RoblesPaula Blanes OrtiLuis García DominguezRafael Martínez LópezManuel Miralles HernándezJosé I Tembl FerrairoÁNgel ChamorroJuan MachoVíctor ObachVincent RiambauLuis San RománFrank J AhlhelmKristine BlackhamStefan EngelterThomas EugsterHenrik GensickeLorenz GürkePhilippe LyrerLuigi MarianiMarina MaurerEdin MujagicMandy MüllerMarios PsychogiosPeter StierliChristoph StippichChristopher TraenkaThomas WolffBenjamin WagnerMartina M WiegertSandra ClarkeMichael DiepersErnst GröchenigLorenz GürkePhilipp GruberAndrej IsaakTimo KahlesRegula MartiKrassen NedeltchevLuca RemondaPeter StierliNadir TissiraMartina Valença FalcãoGert J De BorstRob H LoFrans L MollRaechel TooropBart H Van Der WorpEvert J VonkenJaap L KappelleOmmid JahromeFloris VosWouter SchuilingHendrik Van OverhagenRudolf W M KeunenBob KnippenbergJan J WeverJan W LardenoijeMichel ReijnenLuuk SmeetsSteven Van SterkenburgGustav FraedrichElke GizewskiIngrid GruberMichael KnoflachStefan KiechlBarbara RantnerTimur AbdulamitPatrice BergeronRaymond PadovaniJean-christophe TrastourJean-marie CardonAnne Le Gallou-wittenbergEric AllaireJean-pierre BecqueminFrédéric Cochennec-paliwodaPascal DesgrangesHassan HosseiniHicham KobeiterJean MarzelleMohammed A AlmekhlafiSimerpreet BalPhillip A BarberShelagh B CouttsAndrew M DemchukMuneer EesaMichelle GilliesMayank GoyalMichael D HillMark E HudonAnitha JambulaCarol KenneyGary KleinMarie McclellandAlim MithaBijoy K MenonWilliam F MorrishSteven PetersKarla J RyckborstGreg SamisSupriya SaveEric E SmithPeter StysSuresh SubramaniamGarnette R SutherlandTim WatsonJohn H WongL ZimmelVojko FlisJože MatelaKazimir MiksicFranko MiloticBožidar MrdjaBarbara StirnErih TetickovicMladen GaspariniAnton GradIngrid KomparaZoren MiloševicVeronika PalmisteToomas ToomsooBalzhan AidashovaNursultan KospanovRoman LyssenkoDaulet MussagalievRafi BeyarAaron HoffmanTony KarramArthur KernerEugenia NikolskySamy NiteckiSilva AndonovaChavdar BachvarovVesko PetrovIvan CvjetkoVinko VidjakDamir HalužanMladen PetrunicBao LiuChang-wei LiuDaniel BartkoPeter BenoFrantišek RusnákKamil ZelenákMasayuki EzuraTakashi InoueNaoto KimuraRyushi KondoYasushi MatsumotoHiroaki ShimizuHidenori EndoEisuke FuruiSøren BakkeKristen Krohg-sørensenTerje NomeMona SkjellandBjørn TennøeJoão Albuquerque E CastroGonçalo AlvesFrederico Bastos GonçalvesJosé De Aragão MoraisAna C GarciaHugo ValentimLeonor VasconcelosFernando BelcastroFernando CuraPatricio ZaeffererFoad Abd-allahMohamed H EldessokiHussein Heshmat KassemHaytham Soliman GhariebMary P ColganSyed N HaiderJoe HarbisonPrakash MadhavanDermot MooreGregor ShanikViviane KazanMunier NazzalVicki Ramsey-williams

subject

Malemedicine.medical_specialtyTime FactorsTime Factormedicine.medical_treatmentCarotid StenosiMEDLINECarotid endarterectomyRate ratioRisk AssessmentAsymptomaticlaw.inventionRandomized controlled triallawRisk Factorscarotid artery stenting (CAS); carotid endarterectomy (CEA)StentmedicineHumansCarotid StenosisStrokeEndarterectomyAgedEndarterectomy Carotidbusiness.industrycarotid arteryRisk FactorArticlesGeneral Medicinetrialmedicine.diseaseSettore MED/22 - CHIRURGIA VASCOLARESurgeryStrokeStenosisTreatment Outcomecarotid artery stenting (CAS)Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLAREFemaleStentsHuman medicinemedicine.symptomcarotid endarterectomy (CEA)businessHuman

description

Summary Background Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86–1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91–1·32; p=0·21). Interpretation Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable. Funding UK Medical Research Council and Health Technology Assessment Programme.

yearjournalcountryeditionlanguage
2021-01-01Lancet (London, England)
10.1016/s0140-6736(21)01910-3https://pubmed.ncbi.nlm.nih.gov/35305737