Article Impact Level: HIGH Data Quality: STRONG Summary of The Lancet, 398(10305), 1065–1073. https://doi.org/10.1016/S0140-6736(21)01910-3 Alison Halliday et al.
Points
- The ACST-2 trial compared carotid artery stenting (CAS) and carotid endarterectomy (CEA) in asymptomatic patients with severe carotid artery stenosis.
- The procedural risk of disabling stroke or death was approximately 1% for both CAS and CEA.
- Non-disabling procedural strokes occurred in 2% of CAS and 1.6% of CEA patients.
- Long-term outcomes showed comparable rates of non-procedural strokes resulting in fatality or disability at 2.5% for both CAS and CEA at five years.
- There was no significant difference in the risk of any non-procedural stroke between CAS and CEA procedures.
Summary
This research paper presents the findings of the ACST-2 trial, an international multicentre randomized trial comparing carotid artery stenting (CAS) and carotid endarterectomy (CEA) in asymptomatic patients with severe carotid artery stenosis. The study aimed to assess the long-term protective effects and procedural risks associated with each intervention. A total of 3,625 patients from 130 centers were randomly allocated, with 1,811 assigned to CAS and 1,814 to CEA. The patients were followed up for an average of 5 years.
The results revealed that the procedural risk of disabling stroke or death was approximately 1% for both CAS and CEA. Specifically, 15 patients in the CAS group and 18 in the CEA group experienced these complications. Furthermore, non-disabling procedural strokes occurred in 48 CAS and 29 CEA patients, representing a procedural risk of 2% for CAS and 1.6% for CEA.
Regarding long-term outcomes, the Kaplan-Meier estimates indicated that the 5-year rate of non-procedural strokes resulting in fatality or disability was 2.5% for both CAS and CEA. Moreover, the incidence of any stroke at five years was 5.3% for CAS and 4.5% for CEA. Statistical analysis comparing the two procedures did not demonstrate a significant difference in the risk of any non-procedural stroke, with a rate ratio of 1.16 (95% CI 0.86–1.57, p=0.33).
In conclusion, this study suggests serious complications are similarly rare after competent CAS and CEA interventions, and the long-term effects on fatal or disabling stroke are comparable. These findings provide crucial evidence for clinicians and patients when deciding between carotid artery procedures in asymptomatic individuals with severe stenosis. It emphasizes the importance of considering both the procedural risks and long-term outcomes of CAS and CEA.
Link to the article: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01910-3/fulltext
References Halliday, A., Bulbulia, R., Bonati, L. H., Chester, J., Cradduck-Bamford, A., Peto, R., Pan, H., Halliday, A., Bulbulia, R., Bonati, L. H., Peto, R., Pan, H., Potter, J., Henning Eckstein, H., Farrell, B., Flather, M., Mansfield, A., Mihaylova, B., Rahimi, K., … Ramsey-Williams, V. (2021). Second asymptomatic carotid surgery trial (ACST-2): A randomised comparison of carotid artery stenting versus carotid endarterectomy. The Lancet, 398(10305), 1065–1073. https://doi.org/10.1016/S0140-6736(21)01910-3
