The carotid arteries take blood from the heart to the brain. Carotid artery narrowing causes about 15% of strokes of the type where blood clots block blood flow to the brain (ischaemic stroke). However, it can be treated by either surgery or stenting. Surgery involves a cut of the artery and the removal of fat build-up (endarterectomy). Stenting is a procedure where a mesh tube (a stent) is inserted into the carotid artery to widen it. Unfortunately, both treatments involve risks, including stroke and heart attack, which might cancel out any benefit to the patient.
The first European Carotid Surgery Trial (ECST -1) showed that some patients did benefit from surgery or stenting, however, there have since been advances in the best medical treatment used to prevent stroke, including lowering blood fat, reducing high blood pressure, and preventing blood clotting.
The current study is the second European Carotid Surgery Trial (ECST -2). The aim is to investigate whether surgery or stenting is still worth the additional risk to patients who already have a low risk of stroke due to carotid artery narrowing, when they could instead receive the latest, effective medical treatments of today.
In the trial, the Carotid Artery Risk (CAR) score is used to select 320 patients at low risk of stroke. All will receive optimal medical treatment, although half will additionally receive either immediate surgery or stenting. Each participant will be assessed over two years, which will include a brain scan at the start and end to check for damage caused by ischaemic stroke.
The study hopes to better determine which patients with carotid artery narrowing require surgery or stenting, to maximize long-term, stroke-free survival.