03823nab a2200457 i 4500 publ24190 20240226114730.0 220422s2021 hu o 0|| eng d 0140-6736 10.1016/S0140-6736(21)01910-3 doi 32432432 mtmt SZTE Publicatio Repozitórium hun eng Halliday Alison Second asymptomatic carotid surgery trial (ACST-2) [elektronikus dokumentum] : a randomised comparison of carotid artery stenting versus carotid endarterectomy / Halliday Alison 2021 1065-1073 LANCET 398 No. 10305 Background Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence.Methods ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362.Findings Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow- up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2. 5% in each group for fatal or disabling stroke, and 5.3% with CAS versus 4.5% with CEA for any stroke (rate ratio [RR] 1.16, 95% CI 0.86-1.57; p=0 .33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1.11, 95% CI 0.91-1.32; p=0.21).Interpretation Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable. Klinikai orvostan Bulbulia Richard aut Bonati Leo H. aut Chester Johanna aut Cradduck-Bamford Andrea aut Peto Richard aut Pan Hongchao aut Kollaborációs szervezet: ACST-2 Collaborative Group aut Csobay-Novák Csaba aut Dósa Edit aut Entz László aut Nemes Balázs aut Szeberin Zoltán aut Barzó Pál aut Bodosi M. aut Fako E. aut Fülöp B. aut Németh T. aut Pazdernyik S. aut Skoba K. aut Vörös Erika, Sarolta aut http://publicatio.bibl.u-szeged.hu/24190/2/32432432.pdf Dokumentum-elérés