ACST-2 has randomly allocated 3,625 asymptomatic patients with severe carotid stenosis to (carotid artery stenting) CAS or (carotid endarterectomy) CEA with good compliance and, thus far, a mean of five years of follow-up. The procedures themselves each involved a 1% risk of causing disabling stroke or death but, after each of them, the annual rate of disabling or fatal stroke was only about 0·5%.
This study has more than doubled the number of asymptomatic patients in trials of CAS versus CEA
With ACST-2 included, there is now as much evidence among asymptomatic as among symptomatic patients, and the findings in both types of patients are remarkably similar, with CAS about as effective as CEA at reducing the annual risk of stroke, at least for the first few years.
The trials of CAS versus CEA now provide better evidence than existed before that both procedures carry similar risks and provide comparable benefits
This does not address the question of whether, in addition to good medical therapy, a skilful carotid intervention would be appropriate, nor does it address the question of how much each procedure costs to health services or patients. It does, however, mean that doctors and patients have a freer choice of which procedure is more appropriate for individuals.
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