Assessing the long term outcomes of patients receiving preventative surgery

Patients with substantial narrowing of the carotid artery, a main blood supply to the brain, have increased risk of stroke. Strokes happen when the blood supply to the brain is disrupted. Doctors were previously unsure whether surgery removing some of the fatty deposits in the artery which cause the narrowing, known as carotid endarterectomy, could benefit asymptomatic patients (patients with no previous stroke like symptoms) when balanced against the risks of surgery itself.

The Asymptomatic Carotid Surgery Trial (ACST) compares patient outcomes after immediate surgery with surgery that is deferred. 3,120 patients took part in the study. After five years the trial found that people aged below 75 years of age who had immediate surgery halved their five year risk of stroke from 12 per cent to six per cent. However, changes in health service practice will depend on whether these benefits continue beyond five years. As most patients under 75 years of age will survive 10 years, the researchers need to obtain 10 year results (up to 2008) to determine whether this operation is cost effective.

Scientific Title: Asymptomatic Carotid Surgery Trial (ACST) -10-year results.

With thanks to the BUPA Foundation for supporting this award.

BUPA Foundation gives £179K grant to study stroke prevention

07/09/04 Press Release - Trial finds surgery can halve the risk of stroke (results five years into the ACST trial)

PowerPoint presentation of this research project (159 kb)

This presentation was presented by the researchers at The Stroke Association Scientific Conference in September 2005. 

Classification:
Prevention, Surgical treatment

Publications:

A Halliday. Is it justified and ethical to perform carotid artery stenting in asymptomatic patients? Will we ever know? Vascular, 14 (Supplement 1): S58 2006

A Halliday. Protected carotid artery stenting vs endarterectomy: Design and rationale of the ACST-2 trial. The Irish Journal of Medical Science; 175:41 2006

Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group. Prevention of disabling and fatal strokes by successful endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet; 363: 1491-1502 2004

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