Severe stenosis of the carotid artery (60\u201390%) has been associated with an increased long-term risk of ischaemic stroke. Although carotid endarterectomy can remove the narrowing, the procedure itself is associated with a significant risk of stroke or death.<\/p>\n
The ACST-1 (asymptomatic carotid stenosis) trial randomised 3120 patients to carotid endarterectomy (CEA) or to indefinite deferral of any carotid procedure, and were followed up until death or for a median period amongst survivors of 9\u00a0years. The primary outcomes were death and stroke within 30\u00a0days, and non-perioperative stroke.<\/p>\n
In those undergoing surgery, the perioperative risk of stroke or death within 30\u00a0days was 3.0%. Excluding perioperative events and non-stroke mortality, the stroke risk was 4.1% in the CEA group versus 10.0% in the deferred group at 5\u00a0years. Combining perioperative events and strokes, net risks were 6.9% versus 10.9% at 5\u00a0years, and 13.4% versus 17.9% at 10\u00a0years. Net benefits were seen for both men and women up to 75\u00a0years of age at entry, although not for older patients.<\/p>\n
10-year stroke risk is reduced by successful CEA for severe carotid stenosis in patients younger than 75\u00a0years of age.<\/p>\n