Asymptomatic Carotid Surgery Trial-2 (ACST-2): Rationale for a Randomised Clinical Trial Comparing Carotid Endarterectomy with Carotid Artery Stenting in Patients with Asymptomatic Carotid Artery Stenosis

Rudarakanchana, Nung; Dialynas, Michael; Halliday, Alison

doi:10.1016/j.ejvs.2009.05.010

Cited by 77 publications

(47 citation statements)

References 17 publications

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“…Since CAVATAS, multiple clinical trials have been performed or are in process comparing CAS to CEA for various indications (Andziak 2006;Brott et al 2010;CARESS Steering Committee 2003;Gaines and Randall 2005;International Carotid Stenting Study investigators et al 2010;Rudarakanchana et al 2009;SPACE Collaborative Group et al 2006;Yadav et al 2004). The Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) trial randomized high-risk symptomatic (>50 % stenosis) and asymptomatic patients (>80 % stenosis) to CEA or CAS with distal protection (Yadav et al 2004).…”

Section: Contemporary Randomized Control Trialsmentioning

confidence: 98%

Endovascular Management of Extracranial Carotid Disease

Ikeda¹,

Shaw²,

Sauvageau³

et al. 2015

PanVascular Medicine

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Section: Contemporary Randomized Control Trialsmentioning

confidence: 98%

Endovascular Management of Extracranial Carotid Disease

Ikeda¹,

Shaw²,

Sauvageau³

et al. 2015

PanVascular Medicine

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“…5,7,13,16,18,20,[25][26][27][28][29][30][31] Quality of the information booklet was assessed using the International Patient Decision Aids Standards (IPDAS) guidelines. 32 The readability of three randomly selected paragraphs of 100 words was calculated to give an average reading level of 10 years of school education.…”

Section: Development and Validation Of Information Bookletmentioning

confidence: 99%

“…The absolute risk reduction for endarterectomy is significant but numerically small at around 1% per year. 16,17 If results of the Asymptomatic Carotid Surgery Trial 2 (ACST2), 18 the Asymptomatic Carotid Trial (ACT1), 19 and the Stent Supported Percutaneous Angioplasty of the Carotid Artery versus Endarterectomy 2 (SPACE2) trial 19,20 show similar outcomes between carotid stenting and endarterectomy, two equally valid interventional options may exist. The last trial incorporates a third arm to address the benefit of contemporary BMT alone.…”

mentioning

confidence: 96%

Patient preference survey in the management of asymptomatic carotid stenosis

Jayasooriya

Shalhoub

Thapar

et al. 2011

Journal of Vascular Surgery

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“…17 RESULTS Excluded studies. No data from the ongoing Stent-Protected Angioplasty in Asymptomatic Carotid Artery Stenosis vs Endarterectomy (SPACE2), 18 Asymptomatic Carotid Surgery Trial 2 (ACST-2), 19 and European Carotid Surgery Trial 2 (ECST-2) trials were available on request. Data from Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) were excluded because this was a trial specifically for high risk for endarterectomy patients.…”

mentioning

confidence: 99%

Temporal trends in safety of carotid endarterectomy in asymptomatic patients

et al. 2015

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Objective: To systematically review temporal changes in perioperative safety of carotid endarterectomy (CEA) in asymptomatic individuals in trial and registry studies. Methods:The MEDLINE and EMBASE databases were searched using the terms "carotid" and "endarterectomy" and "asymptomatic" from 1947 to August 23, 2014. Articles dealing with 50%-99% stenosis in asymptomatic individuals were included and low-volume studies were excluded. The primary endpoint was 30-day stroke or death and the secondary endpoint was 30-day all-cause mortality. Statistical analysis was performed using random-effects metaregression for registry data and for trial data graphical interpretation alone was used.Results: Six trials (n 5 4,431 procedures) and 47 community registries (n 5 204,622 procedures) reported data between 1983 and 2013. Registry data showed a significant decrease in postoperative stroke or death incidence over the period 1991-2010, equivalent to a 6% average proportional annual reduction (95% credible interval [CrI] 4%-7%; p , 0.001). Considering postoperative all-cause mortality, registry data showed a significant 5% average proportional annual reduction (95% CrI 3%-9%; p , 0.001). Trial data showed a similar visual trend.Conclusions: CEA is safer than ever before and high-volume registry results closely mirror the results of trials. New benchmarks for CEA are a stroke or death risk of 1.2% and a mortality risk of 0.4%. This information will prove useful for quality improvement programs, for health care funders, and for those re-examining the long-term benefits of asymptomatic revascularization in future trials. Carotid endarterectomy (CEA) in asymptomatic individuals was introduced in the 1970s for long-term prevention of ipsilateral stroke 1 and now comprises the bulk of those undergoing endarterectomy in the United States.2 However, the 10-year absolute risk reduction in stroke or death risk in the largest and most recent trial, the Asymptomatic Carotid Surgery Trial 1 (ACST-1), was only 4.6%, demonstrating small absolute benefit of CEA. 3,4On modern medical therapy, ipsilateral ischemic stroke rates have fallen, 5 with 3 recent cohort studies demonstrating annual ipsilateral ischemic stroke risks in patients with 50%-99% asymptomatic stenosis of 0.3%-0.8%, 6-8 less than the 0.96% risk in ACST. 4 If CEA is to prove effective in the future, one of the prerequisites is that perioperative outcomes must become safer not only in trials, but in wider clinical practice.The aim of this systematic review was to examine temporal trends in perioperative safety of CEA in asymptomatic individuals with 50%-99% internal carotid artery stenosis. When compared with symptomatic patients, 9 the benefits of asymptomatic revascularization are less pronounced, and without marked improvements in operative safety, asymptomatic revascularization faces becoming a historical footnote. This analysis will provide valuable information for From the Academic Section of Vascular Surgery (A.B.M., M.I.Q., A.T.,

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Asymptomatic Carotid Surgery Trial-2 (ACST-2): Rationale for a Randomised Clinical Trial Comparing Carotid Endarterectomy with Carotid Artery Stenting in Patients with Asymptomatic Carotid Artery Stenosis

Cited by 77 publications

References 17 publications

Endovascular Management of Extracranial Carotid Disease

Endovascular Management of Extracranial Carotid Disease

Patient preference survey in the management of asymptomatic carotid stenosis

Temporal trends in safety of carotid endarterectomy in asymptomatic patients

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