ACST-2
Second Asymptomatic Carotid Surgery Trial
Paziente / Popolazione Intervento / Esposizione Confronto Esito
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
Disegno
Open-label, international RCT
Esito
Procedural disabling stroke or death, and non-procedural stroke over a mean 5 years
Rilevanza
2
RisultatoProcedural 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
Discussione e critica
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.