ACST-2
Second Asymptomatic Carotid Surgery Trial
Paciente / Población Intervención / Exposición Comparación Desenlace
In 3,625 asymptomatic patients with severe carotid stenosis, carotid artery stenting produced similar rates of procedural death or disabling stroke and 5-year non-procedural stroke compared with carotid endarterectomy.
N
3625
Diseño
Open-label, international RCT
Desenlace
Procedural disabling stroke or death, and non-procedural stroke over a mean 5 years
Relevancia
2
ResultadoProcedural disabling stroke or death ~1 % in both arms. Five-year non-procedural fatal or disabling stroke 2.5 % in each arm; any non-procedural stroke 5.3 % vs 4.5 % (RR 1.16; 95 % CI 0.86–1.57).
Halliday A, Bulbulia R, et al. Lancet. 2021;398(10305):1065-1073. 10.1016/S0140-6736(21)01910-3
Discusión y crítica
There is no medical-therapy-only arm, so it answers which procedure and not the harder modern question of whether to intervene at all under contemporary statin therapy. Within that frame it is the largest randomised comparison in asymptomatic disease and lets competently performed stenting and surgery count as equivalent.