Deakin University
Browse
peeters-statusupdateand-2013.pdf (568.01 kB)

Status update and interim results from the asymptomatic carotid surgery trial-2 (ACST-2)

Download (568.01 kB)
Version 2 2024-06-04, 06:23
Version 1 2019-05-17, 09:38
journal contribution
posted on 2024-06-04, 06:23 authored by ACST-2 Collaborative Group, Alison Halliday, Richard Bulbulia, William Gray, Ally Naughten, Anne den Hartog, Antonella Delmestri, Carol Wallis, Stephanie le Conte, Sumaira Macdonald, A Peeters
OBJECTIVES: ACST-2 is currently the largest trial ever conducted to compare carotid artery stenting (CAS) with carotid endarterectomy (CEA) in patients with severe asymptomatic carotid stenosis requiring revascularization. METHODS: Patients are entered into ACST-2 when revascularization is felt to be clearly indicated, when CEA and CAS are both possible, but where there is substantial uncertainty as to which is most appropriate. Trial surgeons and interventionalists are expected to use their usual techniques and CE-approved devices. We report baseline characteristics and blinded combined interim results for 30-day mortality and major morbidity for 986 patients in the ongoing trial up to September 2012. RESULTS: A total of 986 patients (687 men, 299 women), mean age 68.7 years (SD ± 8.1) were randomized equally to CEA or CAS. Most (96%) had ipsilateral stenosis of 70-99% (median 80%) with contralateral stenoses of 50-99% in 30% and contralateral occlusion in 8%. Patients were on appropriate medical treatment. For 691 patients undergoing intervention with at least 1-month follow-up and Rankin scoring at 6 months for any stroke, the overall serious cardiovascular event rate of periprocedural (within 30 days) disabling stroke, fatal myocardial infarction, and death at 30 days was 1.0%. CONCLUSIONS: Early ACST-2 results suggest contemporary carotid intervention for asymptomatic stenosis has a low risk of serious morbidity and mortality, on par with other recent trials. The trial continues to recruit, to monitor periprocedural events and all types of stroke, aiming to randomize up to 5,000 patients to determine any differential outcomes between interventions. CLINICAL TRIAL: ISRCTN21144362.

History

Journal

European journal of vascular and endovascular surgery

Volume

46

Pagination

510-518

Location

Amsterdam, The Netherlands

Open access

  • Yes

ISSN

1078-5884

eISSN

1532-2165

Language

eng

Publication classification

C1 Refereed article in a scholarly journal

Copyright notice

2013, Elsevier

Issue

5

Publisher

Elsevier