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Published on: February 13, 2020
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Lessons From ACST-2.
James F Meschia1, Thomas G Brott1
1Vascular Neurology Division, Department of Neurology, Mayo Clinic, Jacksonville, FL.
Stroke
|March 1, 2022
Summary
For asymptomatic carotid stenosis, both stenting and endarterectomy showed similar low periprocedural stroke risks. Further research is needed to confirm if revascularization is still beneficial with modern medical treatments.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurology
Background:
- Asymptomatic carotid stenosis poses a risk of stroke.
- Carotid endarterectomy has been a standard treatment.
- Carotid artery stenting has emerged as an alternative.
Purpose of the Study:
- To compare the safety and efficacy of carotid stenting versus endarterectomy for asymptomatic carotid stenosis.
- To evaluate the long-term stroke risk in patients undergoing these procedures.
- To assess the role of revascularization in the context of contemporary medical management.
Main Methods:
- Analysis of data from the international, multi-center, second Asymptomatic Carotid Surgery Trial (ACST) involving 3625 patients.
- Comparison of periprocedural stroke risk between stenting and endarterectomy groups.
- Estimation of 5-year risk of nonprocedural disabling or fatal stroke.
Main Results:
- The periprocedural risk of disabling or fatal stroke was approximately 1% for both stenting and endarterectomy.
- The estimated 5-year risk of nonprocedural disabling or fatal stroke was 2.5%.
- Stenting by experienced operators demonstrated comparable safety and efficacy to endarterectomy.
Conclusions:
- Carotid artery stenting is a safe and effective alternative to endarterectomy for asymptomatic patients.
- The ongoing CREST-2 trial will determine the continued relevance of revascularization versus intensive medical therapy.
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