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

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorHALLIDAY, Alison
dc.contributor.authorBULBULIA, Richard
dc.contributor.authorBONATI, Leo H.
dc.contributor.authorCHESTER, Johanna
dc.contributor.authorCRADDUCK-BAMFORD, Andrea
dc.contributor.authorPETO, Richard
dc.contributor.authorPAN, Hongchao
dc.contributor.groupauthorACST-2 Collaborative Grp
dc.contributor.groupauthorJR, W Campos
dc.contributor.groupauthorCASELLA, I Benaduce
dc.contributor.groupauthorLUCCIA, N de
dc.contributor.groupauthorESTENSSORO, A Echaime Vallentsits
dc.contributor.groupauthorPRESTI, C
dc.contributor.groupauthorPUECH-LEãO, P
dc.contributor.groupauthorRICARDO, C
dc.contributor.groupauthorSILVA, E S da
dc.contributor.groupauthorJR, C J Sitrângulo
dc.contributor.groupauthorMONTEIRO, J A Tavares
dc.contributor.groupauthorTINONE, G
dc.date.accessioned2022-12-21T13:14:59Z
dc.date.available2022-12-21T13:14:59Z
dc.date.issued2021
dc.description.abstractBackground 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.eng
dc.description.indexMEDLINEeng
dc.description.sponsorshipUK Medical Research Council
dc.description.sponsorshipHealth Technology Assessment Programme
dc.description.sponsorshipMRC [1935732] Funding Source: UKRI
dc.identifier.citationLANCET, v.398, n.10305, p.1065-1073, 2021
dc.identifier.doi10.1016/S0140-6736(21)01910-3
dc.identifier.eissn1474-547X
dc.identifier.issn0140-6736
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/50364
dc.language.isoeng
dc.publisherELSEVIER SCIENCE INCeng
dc.relation.ispartofLancet
dc.rightsrestrictedAccesseng
dc.rights.holderCopyright ELSEVIER SCIENCE INCeng
dc.subject.otherstenosiseng
dc.subject.otherangioplastyeng
dc.subject.wosMedicine, General & Internaleng
dc.titleSecond asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomyeng
dc.typearticleeng
dc.type.categoryoriginal articleeng
dc.type.versionpublishedVersioneng
dspace.entity.typePublication
hcfmusp.affiliation.countryInglaterra
hcfmusp.affiliation.countrySuíça
hcfmusp.affiliation.countryisogb
hcfmusp.affiliation.countryisoch
hcfmusp.author.externalHALLIDAY, Alison:Univ Oxford, Nuffield Dept Populat Hlth, Oxford, England; Univ Oxford, Nuffield Dept Surg, Oxford, England
hcfmusp.author.externalBULBULIA, Richard:Univ Oxford, Nuffield Dept Populat Hlth, Oxford, England; Univ Oxford, Nuffield Dept Populat Hlth, Med Res Council Populat Hlth Res Unit, Oxford, England
hcfmusp.author.externalBONATI, Leo H.:Univ Hosp, Dept Neurol, Basel, Switzerland
hcfmusp.author.externalCHESTER, Johanna:Univ Oxford, Nuffield Dept Populat Hlth, Oxford, England
hcfmusp.author.externalCRADDUCK-BAMFORD, Andrea:Univ Oxford, Nuffield Dept Populat Hlth, Oxford, England
hcfmusp.author.externalPETO, Richard:Univ Oxford, Nuffield Dept Populat Hlth, Oxford, England
hcfmusp.author.externalPAN, Hongchao:Univ Oxford, Nuffield Dept Populat Hlth, Oxford, England; Univ Oxford, Nuffield Dept Populat Hlth, Med Res Council Populat Hlth Res Unit, Oxford, England
hcfmusp.citation.scopus133
hcfmusp.description.beginpage1065
hcfmusp.description.endpage1073
hcfmusp.description.issue10305
hcfmusp.description.volume398
hcfmusp.origemWOS
hcfmusp.origem.scopus2-s2.0-85114686851
hcfmusp.origem.wosWOS:000697368600018
hcfmusp.publisher.cityNEW YORKeng
hcfmusp.publisher.countryUSAeng
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