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Treatment for asymptomatic carotid artery stenosis: surgery or stenting?

Treatment for asymptomatic carotid artery stenosis: surgery or stenting?. Asymptomatic carotid artery stenosis: narrowing that has not yet caused a stroke. Carotid artery surgery (CEA). Asymptomatic carotid surgery trials 1 & 2 . ACST-1: Surgery (CEA) vs no surgery 1993-2008

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Treatment for asymptomatic carotid artery stenosis: surgery or stenting?

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  1. Treatment for asymptomatic carotid artery stenosis: surgery or stenting?

  2. Asymptomatic carotid artery stenosis: narrowing that has not yet caused a stroke

  3. Carotid artery surgery (CEA)

  4. Asymptomatic carotid surgery trials 1 & 2 ACST-1: Surgery (CEA) vs no surgery 1993-2008 (10-year results published in Lancet 2010) ACST-2: Surgery (CEA) vs Stenting, started 2008 - continuing

  5. ACST-1 Final results Lancet 2010: 376:1074-84

  6. ACST-1 3120 patients randomized: Immediate CEA versus control (no CEA unless symptoms occur) ACST-1

  7. ACST-1: hazard from surgery 3%, but then long-term benefit ACST-1

  8. ACST-1: 10-year stroke risk reduced by surgery (CEA) 20 ACST-1 15 Control 15% % 10 CEA 10% 5 2p = 0.0006 0 Years 0 5 10

  9. Stenting might be better than CEA – no incision, quick discharge, no cranial nerve damage…

  10. In asymptomatic carotid stenosis, hazard from stenting is also ~3%* Hazards of CEA and stenting may be similar, but long-term benefits are not yet known *4832 US patients. Circ Cardiovasc Intervent 2009; 2: 159

  11. ACST-2 is comparing:surgery (CEA) versus stent (CAS)

  12. When intervention is definitely planned and CEA and stenting are both possible, RANDOMIZE into ACST-2 Stenting ?? Surgery??

  13. When CEA and stenting are both possible, • RANDOMIZE into ACST-2 by phone or fax Stent Surgery

  14. ACST-2 Use your own usual techniques Use your own usual techniques Stenting Surgery

  15. ACST-2 A large, simple, international trial New collaborators are welcome

  16. ACST-2 For trial information, visit www.acst.org.uk or email us at acst@nds.ox.ac.uk

  17. The NIHR/BUPA FoundationACST-2 a UKCRN adopted trial ISRCTN : 21144362 Clinical Trials.gov Identifier: NCT00883402

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