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Immediate carotid endarterectomy reduced non-perioperative stroke in severe asymptomatic carotid artery stenosis

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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 ★★★★★★☆


Embedded ImageDesign:

randomised controlled trial (MRC Asymptomatic Carotid Surgery Trial [ACST]).

Embedded ImageAllocation:


Embedded ImageBlinding:

blinded (endpoint review committee).*

Embedded ImageFollow up period:

up to 5 years (mean 3.4 y).

Embedded ImageSetting:

126 hospitals in 30 countries.

Embedded ImagePatients:

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 …

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  • * See glossary.

  • For correspondence: Dr A Halliday, ACST Office, St George’s Hospital Medical School, London, UK.

  • Sources of funding: UK Medical Research Council and The Stroke Association.