ACST-2
Second Asymptomatic Carotid Surgery Trial
Patient / Population Intervention / Exposition Comparaison Critère de jugement
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
3 625
Schéma
Open-label, international RCT
Critère
Procedural disabling stroke or death, and non-procedural stroke over a mean 5 years
Pertinence
2
RésultatProcedural 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
Discussion et critique
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.