Asymptomatic Carotid Surgery Trial "ACST"

Completed

Phase N/A Results

Results

Comparing all patients randomized to immediate CEA versus all patients randomized to deferral (combining the perioperative events and non-perioperative strokes), the net 5 year stroke risks were 6.4% vs 11.8% for all strokes (net gain 5.4% [3.0-7.8], p < 0.0001) and 3.5% vs 6.1% for fatal or disabling strokes (net gain 2.5% [0.8-4.3], p < 0.004) and 2.1% vs 4.2% for only fatal strokes (net gain 2.1% [0.6-3.6], p=0.006). The risk of stroke or death within 30 days of CEA was 3.1% (95% CI 2.3-4.1). Comparing all patients excluding such perioperative events, the 5 year stroke risks were 3.8% vs 11% (gain 7.2% [95% CI 5.0-9.4], p<0.0001). Most of this gain was from carotid territoy ischemic strokes - 2.7% vs 9.5% (gain 6.8% [4.8-8.8], p<0.0001). Half of which were disabling or fatal - 1.6% vs 5.3% (gain 3.7% [2.1-5.2], p<0.0001). The results were separately significant for males and females, those with 70-90% carotid artery narrowing on ultrasound, and for those under 65 and 65-74 years old. Ten year results will be available in 2008.