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Q In patients with severe carotid artery stenosis but no recent (⩽6 mo) stroke or ischaemia, is immediate carotid endarterectomy (CEA) more effective than indefinite deferral of any CEA for reducing perioperative mortality and morbidity and incidence of non-perioperative stroke?
Clinical impact ratings GP/FP/Primary care ★★★★★☆☆ IM/Ambulatory care ★★★★★★★ Internal medicine ★★★★★★★ Cardiology ★★★★★★★ Geriatrics ★★★★★★★ Neurology ★★★★★★☆
METHODS
Design:
randomised controlled trial (MRC Asymptomatic Carotid Surgery Trial [ACST]).
Allocation:
concealed.*
Blinding:
blinded (endpoint review committee).*
Follow up period:
up to 5 years (mean 3.4 y).
Setting:
126 hospitals in 30 countries.
Patients:
3120 patients (mean age 68 y, 66% men) who had severe unilateral or bilateral carotid artery stenosis (⩾60% diameter reduction on ultrasonography) but no stroke or ischaemia in the previous 6 months, for whom both physician and patient were substantially uncertain whether to choose immediate CEA or …