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10-year stroke prevention after successful carotidendarterectomy for asymptomatic stenosis (ACST-1):a multicentre randomised trial

Title:	10-year stroke prevention after successful carotidendarterectomy for asymptomatic stenosis (ACST-1):a multicentre randomised trial
Authors:	Asymptomatic Carotid Surgery Trial Collaborative Group; Collaborators; Fraedrich G; Schmidauer C; Hölzenbein TH; Huk I; Haumer M; Kretschmer G; Metz V; Polterauer P; Teufelsbauer H; Cras P; Hendriks J; Lauwers P; Van Schil P; de Souza EB; Dourado ME; Gurgel G; Rocha GM; Petrov V; Slabakov G; Cooper ME; Gubitz G; Holness R; Howes W; Langille R; Legg K; Nearing S; MacKean G; MacKay M; Phillips SJ; Sullivan J; Wood J; Erdelez L; Sosa T; Angelides NS; Christopoulos G; Malikidou A; Pesta A; Ambler Z; Mracek J; Polivka J; Rohan V; Sevcik P; Simaná J; Benes V; Kramár F; Kaste M; Lepäntalo M; Soinne L; Cardon JM; Legalou A; Gengenbach B; Pfadenhauer K; Wölfl KD; Flessenkämper I; Klumpp BF; Marsch J; Kolvenbach R; Pfeiff T; Sandmann W; Beyersdorf F; Hetzel A; Sarai K; Schöllhorn J; Spillner G; Lutz HJ; Böckler D; Maeder N; Busse O; Grönniger J; Haukamp F; Balzer K; Knoob HG; Roedig G; Virreira L; Franke S; Moll R; Schneider J; Dayantas J; Sechas MN; Tsiaza S; Kiskinis D; Apor A; Dzinich C; Entz L; Hüttl K; Jàrànyi Z; Mogan I; Nagy Z; Szabo A; Varga D; Juhász G; Mátyás L; Hutchinson M; Mehigan D; Aladjem Z; Harah E; Elmakias S; Gurvich D; Yoffe B; Ben Meir H; Dagan L; Karmeli R; Keren G; Shimony A; Weller B; Avrahami R; Koren R; Streifler JY; Tabachnik S; Zelikovski A; Angiletta D; Federico F; Impedovo G; Marotta V; Pascazio L; Regina G; Andreoli A; Pozzati E; Bonardelli S; Giulini SM; Guarneri B; Caiazzo P; Mascoli F; Becchi G; Masini R; Santoro E; Simoni G; Ventura M; Scarpelli P; Spartera C; Arena O; Collice M; Puttini M; Romani F; Santilli I; Segramora V; Sterzi R; Deriu G; Verlato F; Cao PG; Cieri E; De Rango P; Moggi L; Ricci S; Antico A; Spigonardo F; Malferrari G; Tusini N; Vecchiati E; Cavallaro A; Kasemi H; Marino M; Sbarigia E; Speziale F; Zinicola N; ALO', Francesco Paolo; BARTOLINI, MARCO; Carbonari L; Caporelli S; Grili Cicilioni C; Lagalla G; Ioannidis G; Pagliariccio G; SILVESTRINI, Mauro; Palombo D; Peinetti F; Adovasio R; Chiodo Grandi F; Mase G; Zamolo F; Fregonese V; Gonano N; Mozzon L; Blair R; Chuen J; Ferrar D; Garbowski M; Hamilton MJ; Holdaway C; Muthu S; Shakibaie F; Vasudevan TM; Kroese A; Slagsvold CE; Dahl T; Johnsen HJ; Lange C; Myhre HO; Gniadek J; Andziak P; Elwertowski M; Leszczynski J; Malek AK; Mieszkowski J; Noszczyk W; Szostek M; Toutounchi S; Correia C; Pereira MC; Akchurin RS; Flis V; Miksic K; Stirn B; Tetickovic E; Cairols M; Capdevila JM; Iborra Ortega E; Obach V; Riambau V; Vidal Barraquer F; Vila Coll R; Diaz Vidal E; Iglesias Negreia JI; Tovar Pardo A; Iglesias RJ; Alfageme AF; Barba Velez A; Estallo Laliena L; Garcia Monco JC; Gonzalez LR; Corominas C; Julia J; Lozano P; Marti Masso JF; Porta RM; Carrera AR; Gomez J; Blomstrand C; Gelin J; Holm J; Karlström L; Mattsson E; Bornhov S; Dahlstrom J; De Pedis G; Jensen SM; Pärsson H; Plate G; Qvarfordt P; Arvidsson B; Brattström L; Forssell C; Potemkowski A; Skiöldebrand C; Stoor P; Blomqvist M; Calander M; Lundgren F; Almqvist H; Norgren L; Norrving B; Ribbe E; Thörne J; Gottsäter A; Mätzsch T; Nilsson ME; Lonsson M; Stahre B; Stenberg B; Konrad P; Jarl L; Lundqvist L; Olofsson P; Rosfors S; Swedenborg J; Takolander R; Bergqvist D; Ljungman C; Kniemeyer HW; Widmer MK; Kuster R; Kaiser R; Nagel W; Sege D; Weder B; De Nie J; Doelman J; Yilmaz N; Buth J; Stultiens G; Boiten J; Boon A; van der Linden F; Busman DC; Sinnige HA; Yo TI; de Borst GJ; Eikelboom BC; Kappelle LJ; Moll F; Dortland RW; Westra TE; Jaber H; Manaa J; Meftah RB; Nabil BR; Sraieb T; Bateman D; Budd J; Horrocks M; Kivela M; Shaw L; Walker R; D'Sa AA; Fullerton K; Hannon R; Hood JM; Lee B; McGuigan K; Morrow J; Reid J; Soong CV; Simms M; Baird R; Campbell M; Cole S; Ferguson IT; Lamont P; Mitchell D; Sassano A; Smith FC; Blake K; Kirkpatrick PJ; Martin P; Turner C; Clegg JF; Crosley M; Hall J; De Cossart L; Edwards P; Fletcher D; Rosser S; McCollum PT; Davidson D; Levison R; Bradbury AW; Chalmers RT; Dennis M; Murie J; Ruckley CV; Sandercock P; Campbell WB; Frankel T; Gardner Thorpe C; Gutowski N; Hardie R; Honan W; Niblett P; Peters A; Ridler B; Thompson JF; Bone I; Welch G; Grocott EC; Overstall P; Aldoori MI; Dafalla BE; Bryce J; Clarke C; Ming A; Wilkinson AR; Bamford J; Berridge D; Scott J; Abbott RJ; Naylor R; Harris P; Humphrey P; Adiseshiah M; Aukett M; Baker D; Bishop CC; Boutin A; Brown M; Burke P; Burnand KG; Colchester A; Coward L; Davies AH; Espasandin M; Giddings AE; Hamilton G; Harrison M; Judge C; Kakkos S; Mansfield A; McGuiness C; Morris Vincent P; Nicolaides A; Padayachee TS; Riordan H; Sullivan E; Taylor P; Thomas D; Thompson M; Wolfe JH; McCollum CN; O'Neill PA; Welsh S; Barnes J; Cleland P; Davis M; Gholkar A; Jones R; Jaykishnam V; Mendelow AD; O'Connell JE; Siddique MS; Stansby G; Vivar R; Ashley S; Cosgrove C; Gibson J; Wilkins DC; Chant AD; Frankel J; Shearman CP; Williams J; Hall G; Holdsworth R; Davies JN; McLean B; Woodburn KR; Brown G; Curley P; Loizou L; Chaturvedi S; Diaz F; Radak D; Todorovic PR; Kamugasha D; Baxter A; Berry C; Burrett J; Collins R; Crowther J; Davies C; Farrell B; Godwin J; Gray R; Harwood C; Hirt L; Hope C; Knight S; Lay M; Munday A; Murawska A; Peto CG; Radley A; Richards S.
Contributors:	Asymptomatic Carotid Surgery Trial Collaborative, Group; Collaborators; Fraedrich, G; Schmidauer, C; Hölzenbein, Th; Huk, I; Haumer, M; Kretschmer, G; Metz, V; Polterauer, P; Teufelsbauer, H; Cras, P; Hendriks, J; Lauwers, P; Van Schil, P; de Souza, Eb; Dourado, Me; Gurgel, G; Rocha, Gm; Petrov, V; Slabakov, G; Cooper, Me; Gubitz, G; Holness, R; Howes, W; Langille, R; Legg, K; Nearing, S; Mackean, G; Mackay, M; Phillips, Sj; Sullivan, J; Wood, J; Erdelez, L; Sosa, T; Angelides, N; Christopoulos, G; Malikidou, A; Pesta, A; Ambler, Z; Mracek, J; Polivka, J; Rohan, V; Sevcik, P; Simaná, J; Benes, V; Kramár, F; Kaste, M; Lepäntalo, M; Soinne, L; Cardon, Jm; Legalou, A; Gengenbach, B; Pfadenhauer, K; Wölfl, Kd; Flessenkämper, I; Klumpp, Bf; Marsch, J; Kolvenbach, R; Pfeiff, T; Sandmann, W; Beyersdorf, F; Hetzel, A; Sarai, K; Schöllhorn, J; Spillner, G; Lutz, Hj; Böckler, D; Maeder, N; Busse, O; Grönniger, J; Haukamp, F; Balzer, K; Knoob, Hg; Roedig, G; Virreira, L; Franke, S; Moll, R; Schneider, J; Dayantas, J; Sechas, Mn; Tsiaza, S; Kiskinis, D; Apor, A; Dzinich, C; Entz, L; Hüttl, K; Jàrànyi, Z; Mogan, I; Nagy, Z; Szabo, A; Varga, D; Juhász, G; Mátyás, L; Hutchinson, M; Mehigan, D; Aladjem, Z; Harah, E; Elmakias, S; Gurvich, D
Publication Year:	2010
Collection:	Università Politecnica delle Marche: IRIS
Description:	Backgroun: If carotid artery narrowing remains asymptomatic (ie, has caused no recent stroke or other neurological symptoms), successful carotid endarterectomy (CEA) reduces stroke incidence for some years. We assessed the longterm effects of successful CEA. Methods Between 1993 and 2003, 3120 asymptomatic patients from 126 centres in 30 countries were allocated equally, by blinded minimised randomisation, to immediate CEA (median delay 1 month, IQR 0·3–2·5) or to indefi nite deferral of any carotid procedure, and were followed up until death or for a median among survivors of 9 years (IQR 6–11). The primary outcomes were perioperative mortality and morbidity (death or stroke within 30 days) and non-perioperative stroke. Kaplan-Meier percentages and logrank p values are from intention-to-treat analyses. This study is registered, number ISRCTN26156392. Findings 1560 patients were allocated immediate CEA versus 1560 allocated deferral of any carotid procedure. The proportions operated on while still asymptomatic were 89·7% versus 4·8% at 1 year (and 92·1% vs 16·5% at 5 years). Perioperative risk of stroke or death within 30 days was 3·0% (95% CI 2·4–3·9; 26 non-disabling strokes plus 34 disabling or fatal perioperative events in 1979 CEAs). Excluding perioperative events and non-stroke mortality, stroke risks (immediate vs deferred CEA) were 4·1% versus 10·0% at 5 years (gain 5·9%, 95% CI 4·0–7·8) and 10·8% versus 16·9% at 10 years (gain 6·1%, 2·7–9·4); ratio of stroke incidence rates 0·54, 95% CI 0·43–0·68, p
Document Type:	article in journal/newspaper
Language:	English
Relation:	volume:376; firstpage:1074; lastpage:1084; journal:THE LANCET; https://hdl.handle.net/11566/69622
Availability:	https://hdl.handle.net/11566/69622
Accession Number:	edsbas.308458EB
Database:	BASE