Carotid artery stenting (CAS) and carotid endarterectomy (CEA) have comparable long-term effects on fatal or disabling stroke in asymptomatic patients with severe carotid artery stenosis, according to findings from the ACST-2 trial presented during ESC Congress 2021 and published in The Lancet.

Researchers randomized 3,625 patients with severe unilateral or bilateral carotid artery stenosis to either CAS (n=1,811) or CEA (n=1,814). Patients were then followed up at one month and then annually for an average of five years. The primary outcomes were: 1) procedural risks (morbidity and mortality within one month after the procedure); and 2) non-procedural stroke, subdivided by severity.

Overall results indicated 1% of patients in both groups experienced procedural stroke or death (15 CAS/18 CEA), while 2% experienced non-disabling procedural stroke (48 CAS/29 CEA). According to researchers, Kaplan-Meier estimates of five-year non-procedural stroke were 2.5% in each group for fatal or disabling stroke.

"We have shown that, for patients with a severely narrowed carotid artery, stenting and surgery have similar effects on the chances of having a disabling or fatal stroke," said principal investigator Alison Halliday, MD. "The risk from each procedure is about 1%. After that, however, the annual risk over the next five or more years is halved, from 1% down to 0.5% per year."

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Vascular Medicine, Interventions and Imaging, Interventions and Vascular Medicine, Angiography, Nuclear Imaging

Keywords: ESC Congress, ESC21, Carotid Stenosis, Stents, Angioplasty, Balloon, Percutaneous Coronary Intervention, Angiography, ACC International

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