10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis (ACST-1): A multicentre randomised trial

Alison Halliday, Michael Harrison, Elizabeth Hayter, Xiangling Kong, Averil Mansfield, Joanna Marro, Hongchao Pan, Richard Peto, John Potter, Kazem Rahimi, Angela Rau, Steven Robertson, Jonathan Streifler, Dafydd Thomas, G. Fraedrich, C. Schmidauer, T. H. Hölzenbein, I. Huk, M. Haumer, G. KretschmerV. Metz, P. Polterauer, H. Teufelsbauer, P. Cras, J. Hendriks, P. Lauwers, P. van Schil, E. Barreto de Souza, M. Emilio Dourado, G. Gurgel, G. Myrian Rocha, V. Petrov, G. Slabakov, M. E. Cooper, G. Gubitz, R. Holness, W. Howes, R. Langille, K. Legg, S. Nearing, G. MacKean, M. MacKay, S. J. Phillips, J. Sullivan, J. Wood, L. Erdelez, T. Sosa, N. S. Angelides, G. Christopoulos, A. Malikidou, A. Pesta, Z. Ambler, J. Mracek, J. Polivka, V. Rohan, P. Sevcik, J. Simaná, V. Beneš, F. Kramár, M. Kaste, M. Lepäntalo, L. Soinne, J. M. Cardon, A. Legalou, B. Gengenbach, K. Pfadenhauer, K. D. Wölfle, I. Flessenkämper, B. F. Klumpp, J. Marsch, R. Kolvenbach, T. Pfeiffer, W. Sandmann, F. Beyersdorf, A. Hetzel, K. Sarai, J. Schöllhorn, G. Spillner, H. J. Lutz, D. Böckler, N. Maeder, O. Busse, J. Grönniger, F. Haukamp, K. Balzer, H. G. Knoob, G. Roedig, L. Virreira, S. Franke, R. Moll, J. Schneider, J. Dayantas, M. N. Sechas, S. Tsiaza, D. Kiskinis, A. Apor, C. Dzinich, L. Entz, K. Hüttl, Z. Jàrànyi, I. Mogan, Z. Nagy, A. Szabo, D. Varga, G. Juhász, L. Mátyás, M. Hutchinson, D. Mehigan, Z. Aladjem, E. Harah, S. Elmakias, D. Gurvich, B. Yoffe, H. Ben-Meir, L. Dagan, R. Karmeli, G. Keren, A. Shimony, B. Weller, R. Avrahami, A. Koren, J. Y. Streifler, S. Tabachnik, A. Zelikovski, D. Angiletta, F. Federico, G. Impedovo, V. Marotta, L. Pascazio, G. Regina, A. Andreoli, E. Pozzati, S. Bonardelli, S. M. Giulini, B. Guarneri, P. Caiazzo, F. Mascoli, G. Becchi, R. Masini, E. Santoro, G. Simoni, M. Ventura, P. Scarpelli, C. Spartera, O. Arena, M. Collice, M. Puttini, F. Romani, I. Santilli, V. Segramora, R. Sterzi, G. Deriu, F. Verlato, P. G. Cao, E. Cieri, P. de Rango, L. Moggi, S. Ricci, A. Antico, F. Spigonardo, G. Malferrari, N. Tusini, E. Vecchiati, A. Cavallaro, H. Kasemi, M. Marino, E. Sbarigia, F. Speziale, N. Zinicola, F. P. Alò, M. Bartolini, L. Carbonari, S. Caporelli, C. Grili-Cicilioni, G. Lagalla, G. Ioannidis, G. Pagliariccio, M. Silvestrini, D. Palombo, F. Peinetti, R. Adovasio, F. Chiodo-Grandi, G. Mase, F. Zamolo, V. Fregonese, N. Gonano, L. Mozzon, R. Blair, J. Chuen, D. Ferrar, M. Garbowski, M. J. Hamilton, C. Holdaway, S. Muthu, F. Shakibaie, T. M. Vasudevan, A. Kroese, C. E. Slagsvold, T. Dahl, H. J. Johnsen, C. Lange, H. O. Myhre, J. Gniadek, P. Andziak, M. Elwertowski, J. Leszczynski, A. K. Malek, J. Mieszkowski, W. Noszczyk, M. Szostek, S. Toutounchi, C. Correia, M. C. Pereira, R. S. Akchurin, V. Flis, K. Miksic, B. Stirn, E. Tetickovic, M. Cairols, J. M. Capdevila, E. Iborra-Ortega, V. Obach, V. Riambau, F. Vidal-Barraquer, R. Vila-Coll, E. Diaz-Vidal, J. I. Iglesias-Negreia, A. Tovar-Pardo, R. J. Segura Iglesias, A. F. Alfageme, A. Barba-Velez, L. Estallo-Laliena, J. C. Garcia-Monco, L. Rodriguez Gonzalez, C. Corominas, J. Julia, P. Lozano, J. F. Marti-Masso, R. M. Porta, A. Rosendo Carrera, J. Gomez, C. Blomstrand, J. Gelin, J. Holm, L. Karlström, E. Mattsson, S. Bornhov, J. Dahlstrom, G. de Pedis, S. M. Jensen, H. Pärsson, G. Plate, P. Qvarfordt, B. Arvidsson, L. Brattström, C. Forssell, A. Potemkowski, C. Skiöldebrand, P. Stoor, M. Blomqvist, M. Calander, C. Forssell, F. Lundgren, H. Almqvist, L. Norgren, B. Norrving, E. Ribbe, J. Thörne, A. Gottsäter, T. Mätzsch, M. E. Nilsson, C. Forssell, M. Lonsson, F. Lundgren, B. Stahre, L. Norgren, B. Stenberg, P. Konrad, L. Jarl, L. Lundqvist, P. Olofsson, S. Rosfors, C. Skiöldebrand, J. Swedenborg, R. Takolander, D. Bergqvist, C. Ljungman, H. Pärsson, H. W. Kniemeyer, M. K. Widmer, R. Kuster, R. Kaiser, W. Nagel, D. Sege, B. Weder, J. de Nie, J. Doelman, N. Yilmaz, J. Buth, G. Stultiens, J. Boiten, A. Boon, F. van der Linden, D. C. Busman, H. A W Sinnige, T. I. Yo, G. J. de Borst, B. C. Eikelboom, L. J. Kappelle, F. Moll, R. W H van Reedt Dortland, T. E. Westra, H. Jaber, J. Manaa, R. B. Meftah, B. R. Nabil, T. Sraieb, D. Bateman, J. Budd, M. Horrocks, M. Kivela, L. Shaw, R. Walker, A. A B Barros D'Sa, M. Simms, R. Baird, M. Campbell, S. Cole, I. T. Ferguson, P. Lamont, D. Mitchell, A. Sassano, F. C T Smith, K. Blake, P. J. Kirkpatrick, P. Martin, C. Turner, J. F. Clegg, M. Crosley, J. Hall, L. de Cossart, P. Edwards, D. Fletcher, S. Rosser, P. T. McCollum, D. Davidson, R. Levison, A. W. Bradbury, R. T A Chalmers, M. Dennis, J. Murie, C. V. Ruckley, P. Sandercock, W. B. Campbell, T. Frankel, C. Gardner-Thorpe, N. Gutowski, R. Hardie, W. Honan, P. Niblett, A. Peters, B. Ridler, J. F. Thompson, I. Bone, G. Welch, E. C. Grocott, P. Overstall, M. I. Aldoori, B. E A Dafalla, J. Bryce, C. Clarke, P. T. McCollum, A. Ming, A. R. Wilkinson, J. Bamford, D. Berridge, J. Scott, R. J. Abbott, R. Naylor, P. Harris, P. Humphrey, M. Adiseshiah, M. Aukett, D. Baker, C. C R Bishop, A. Boutin, M. Brown, P. Burke, K. G. Burnand, A. Colchester, L. Coward, A. H. Davies, M. Espasandin, A. E B Giddings, G. Hamilton, C. Judge, S. Kakkos, C. McGuiness, P. Morris-Vincent, A. Nicolaides, T. S. Padayachee, H. Riordan, E. Sullivan, P. Taylor, M. Thompson, J. H N Wolfe, C. N. McCollum, P. A. O'Neill, S. Welsh, J. Barnes, P. Cleland, M. Davis, A. Gholkar, R. Jones, V. Jaykishnam, A. D. Mendelow, J. E. O'Connell, M. S S Siddique, G. Stansby, R. Vivar, S. Ashley, C. Cosgrove, J. Gibson, D. C. Wilkins, A. D B Chant, J. Frankel, C. P. Shearman, J. Williams, G. Hall, R. Holdsworth, J. N. Davies, B. McLean, K. R. Woodburn, G. Brown, P. Curley, L. Loizou, Seemant Chaturvedi, F. Diaz, D. Radak, P. R. Todorovic, D. Kamugasha, A. Baxter, C. Berry, J. Burrett, R. Collins, J. Crowther, C. Davies, B. Farrell, J. Godwin, R. Gray, C. Harwood, L. Hirt, C. Hope, S. Knight, M. Lay, A. Munday, A. Murawska, C. G. Peto, A. Radley, S. Richards

Research output: Contribution to journalArticle

467 Citations (Scopus)

Abstract

Background 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 long-term 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 indefinite 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

Original languageEnglish (US)
Pages (from-to)1074-1084
Number of pages11
JournalThe Lancet
Volume376
Issue number9746
DOIs
StatePublished - Sep 25 2010
Externally publishedYes

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Carotid Endarterectomy
Multicenter Studies
Pathologic Constriction
Stroke
Intention to Treat Analysis
Mortality
Carotid Stenosis
Incidence
Random Allocation
Survivors
Morbidity

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Halliday, A., Harrison, M., Hayter, E., Kong, X., Mansfield, A., Marro, J., ... Richards, S. (2010). 10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis (ACST-1): A multicentre randomised trial. The Lancet, 376(9746), 1074-1084. https://doi.org/10.1016/S0140-6736(10)61197-X

10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis (ACST-1) : A multicentre randomised trial. / Halliday, Alison; Harrison, Michael; Hayter, Elizabeth; Kong, Xiangling; Mansfield, Averil; Marro, Joanna; Pan, Hongchao; Peto, Richard; Potter, John; Rahimi, Kazem; Rau, Angela; Robertson, Steven; Streifler, Jonathan; Thomas, Dafydd; Fraedrich, G.; Schmidauer, C.; Hölzenbein, T. H.; Huk, I.; Haumer, M.; Kretschmer, G.; Metz, V.; Polterauer, P.; Teufelsbauer, H.; Cras, P.; Hendriks, J.; Lauwers, P.; van Schil, P.; de Souza, E. Barreto; Emilio Dourado, M.; Gurgel, G.; Myrian Rocha, G.; Petrov, V.; Slabakov, G.; Cooper, M. E.; Gubitz, G.; Holness, R.; Howes, W.; Langille, R.; Legg, K.; Nearing, S.; MacKean, G.; MacKay, M.; Phillips, S. J.; Sullivan, J.; Wood, J.; Erdelez, L.; Sosa, T.; Angelides, N. S.; Christopoulos, G.; Malikidou, A.; Pesta, A.; Ambler, Z.; Mracek, J.; Polivka, J.; Rohan, V.; Sevcik, P.; Simaná, J.; Beneš, V.; Kramár, F.; Kaste, M.; Lepäntalo, M.; Soinne, L.; Cardon, J. M.; Legalou, A.; Gengenbach, B.; Pfadenhauer, K.; Wölfle, K. D.; Flessenkämper, I.; Klumpp, B. F.; Marsch, J.; Kolvenbach, R.; Pfeiffer, T.; Sandmann, W.; Beyersdorf, F.; Hetzel, A.; Sarai, K.; Schöllhorn, J.; Spillner, G.; Lutz, H. J.; Böckler, D.; Maeder, N.; Busse, O.; Grönniger, J.; Haukamp, F.; Balzer, K.; Knoob, H. G.; Roedig, G.; Virreira, L.; Franke, S.; Moll, R.; Schneider, J.; Dayantas, J.; Sechas, M. N.; 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, A.; Streifler, J. Y.; Tabachnik, S.; Zelikovski, A.; Angiletta, D.; Federico, F.; Impedovo, G.; Marotta, V.; Pascazio, L.; Regina, G.; Andreoli, A.; Pozzati, E.; Bonardelli, S.; Giulini, S. M.; 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, P. G.; 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.; Alò, F. P.; Bartolini, M.; Carbonari, L.; Caporelli, S.; Grili-Cicilioni, C.; Lagalla, G.; Ioannidis, G.; Pagliariccio, G.; Silvestrini, M.; 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, M. J.; Holdaway, C.; Muthu, S.; Shakibaie, F.; Vasudevan, T. M.; Kroese, A.; Slagsvold, C. E.; Dahl, T.; Johnsen, H. J.; Lange, C.; Myhre, H. O.; Gniadek, J.; Andziak, P.; Elwertowski, M.; Leszczynski, J.; Malek, A. K.; Mieszkowski, J.; Noszczyk, W.; Szostek, M.; Toutounchi, S.; Correia, C.; Pereira, M. C.; Akchurin, R. S.; Flis, V.; Miksic, K.; Stirn, B.; Tetickovic, E.; Cairols, M.; Capdevila, J. M.; Iborra-Ortega, E.; Obach, V.; Riambau, V.; Vidal-Barraquer, F.; Vila-Coll, R.; Diaz-Vidal, E.; Iglesias-Negreia, J. I.; Tovar-Pardo, A.; Segura Iglesias, R. J.; Alfageme, A. F.; Barba-Velez, A.; Estallo-Laliena, L.; Garcia-Monco, J. C.; Rodriguez Gonzalez, L.; Corominas, C.; Julia, J.; Lozano, P.; Marti-Masso, J. F.; Porta, R. M.; Rosendo Carrera, A.; Gomez, J.; Blomstrand, C.; Gelin, J.; Holm, J.; Karlström, L.; Mattsson, E.; Bornhov, S.; Dahlstrom, J.; de Pedis, G.; Jensen, S. M.; Pärsson, H.; Plate, G.; Qvarfordt, P.; Arvidsson, B.; Brattström, L.; Forssell, C.; Potemkowski, A.; Skiöldebrand, C.; Stoor, P.; Blomqvist, M.; Calander, M.; Forssell, C.; Lundgren, F.; Almqvist, H.; Norgren, L.; Norrving, B.; Ribbe, E.; Thörne, J.; Gottsäter, A.; Mätzsch, T.; Nilsson, M. E.; Forssell, C.; Lonsson, M.; Lundgren, F.; Stahre, B.; Norgren, L.; Stenberg, B.; Konrad, P.; Jarl, L.; Lundqvist, L.; Olofsson, P.; Rosfors, S.; Skiöldebrand, C.; Swedenborg, J.; Takolander, R.; Bergqvist, D.; Ljungman, C.; Pärsson, H.; Kniemeyer, H. W.; Widmer, M. K.; 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, D. C.; Sinnige, H. A W; Yo, T. I.; de Borst, G. J.; Eikelboom, B. C.; Kappelle, L. J.; Moll, F.; van Reedt Dortland, R. W H; Westra, T. E.; Jaber, H.; Manaa, J.; Meftah, R. B.; Nabil, B. R.; Sraieb, T.; Bateman, D.; Budd, J.; Horrocks, M.; Kivela, M.; Shaw, L.; Walker, R.; D'Sa, A. A B Barros; Simms, M.; Baird, R.; Campbell, M.; Cole, S.; Ferguson, I. T.; Lamont, P.; Mitchell, D.; Sassano, A.; Smith, F. C T; Blake, K.; Kirkpatrick, P. J.; Martin, P.; Turner, C.; Clegg, J. F.; Crosley, M.; Hall, J.; de Cossart, L.; Edwards, P.; Fletcher, D.; Rosser, S.; McCollum, P. T.; Davidson, D.; Levison, R.; Bradbury, A. W.; Chalmers, R. T A; Dennis, M.; Murie, J.; Ruckley, C. V.; Sandercock, P.; Campbell, W. B.; Frankel, T.; Gardner-Thorpe, C.; Gutowski, N.; Hardie, R.; Honan, W.; Niblett, P.; Peters, A.; Ridler, B.; Thompson, J. F.; Bone, I.; Welch, G.; Grocott, E. C.; Overstall, P.; Aldoori, M. I.; Dafalla, B. E A; Bryce, J.; Clarke, C.; McCollum, P. T.; Ming, A.; Wilkinson, A. R.; Bamford, J.; Berridge, D.; Scott, J.; Abbott, R. J.; Naylor, R.; Harris, P.; Humphrey, P.; Adiseshiah, M.; Aukett, M.; Baker, D.; Bishop, C. C R; Boutin, A.; Brown, M.; Burke, P.; Burnand, K. G.; Colchester, A.; Coward, L.; Davies, A. H.; Espasandin, M.; Giddings, A. E B; Hamilton, G.; Judge, C.; Kakkos, S.; McGuiness, C.; Morris-Vincent, P.; Nicolaides, A.; Padayachee, T. S.; Riordan, H.; Sullivan, E.; Taylor, P.; Thompson, M.; Wolfe, J. H N; McCollum, C. N.; O'Neill, P. A.; Welsh, S.; Barnes, J.; Cleland, P.; Davis, M.; Gholkar, A.; Jones, R.; Jaykishnam, V.; Mendelow, A. D.; O'Connell, J. E.; Siddique, M. S S; Stansby, G.; Vivar, R.; Ashley, S.; Cosgrove, C.; Gibson, J.; Wilkins, D. C.; Chant, A. D B; Frankel, J.; Shearman, C. P.; Williams, J.; Hall, G.; Holdsworth, R.; Davies, J. N.; McLean, B.; Woodburn, K. R.; Brown, G.; Curley, P.; Loizou, L.; Chaturvedi, Seemant; Diaz, F.; Radak, D.; Todorovic, P. R.; 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, C. G.; Radley, A.; Richards, S.

In: The Lancet, Vol. 376, No. 9746, 25.09.2010, p. 1074-1084.

Research output: Contribution to journalArticle

Halliday, A, Harrison, M, Hayter, E, Kong, X, Mansfield, A, Marro, J, Pan, H, Peto, R, Potter, J, Rahimi, K, Rau, A, Robertson, S, Streifler, J, Thomas, D, 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, Emilio Dourado, M, Gurgel, G, Myrian Rocha, G, 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, Beneš, V, Kramár, F, Kaste, M, Lepäntalo, M, Soinne, L, Cardon, JM, Legalou, A, Gengenbach, B, Pfadenhauer, K, Wölfle, KD, Flessenkämper, I, Klumpp, BF, Marsch, J, Kolvenbach, R, Pfeiffer, 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, A, 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, Alò, FP, Bartolini, M, Carbonari, L, Caporelli, S, Grili-Cicilioni, C, Lagalla, G, Ioannidis, G, Pagliariccio, G, Silvestrini, M, 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, Segura Iglesias, RJ, Alfageme, AF, Barba-Velez, A, Estallo-Laliena, L, Garcia-Monco, JC, Rodriguez Gonzalez, L, Corominas, C, Julia, J, Lozano, P, Marti-Masso, JF, Porta, RM, Rosendo Carrera, A, 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, Forssell, C, Lundgren, F, Almqvist, H, Norgren, L, Norrving, B, Ribbe, E, Thörne, J, Gottsäter, A, Mätzsch, T, Nilsson, ME, Forssell, C, Lonsson, M, Lundgren, F, Stahre, B, Norgren, L, Stenberg, B, Konrad, P, Jarl, L, Lundqvist, L, Olofsson, P, Rosfors, S, Skiöldebrand, C, Swedenborg, J, Takolander, R, Bergqvist, D, Ljungman, C, Pärsson, H, 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, HAW, Yo, TI, de Borst, GJ, Eikelboom, BC, Kappelle, LJ, Moll, F, van Reedt Dortland, RWH, 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, AABB, Simms, M, Baird, R, Campbell, M, Cole, S, Ferguson, IT, Lamont, P, Mitchell, D, Sassano, A, Smith, FCT, 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, RTA, 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, BEA, Bryce, J, Clarke, C, McCollum, PT, 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, CCR, Boutin, A, Brown, M, Burke, P, Burnand, KG, Colchester, A, Coward, L, Davies, AH, Espasandin, M, Giddings, AEB, Hamilton, G, Judge, C, Kakkos, S, McGuiness, C, Morris-Vincent, P, Nicolaides, A, Padayachee, TS, Riordan, H, Sullivan, E, Taylor, P, Thompson, M, Wolfe, JHN, 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, MSS, Stansby, G, Vivar, R, Ashley, S, Cosgrove, C, Gibson, J, Wilkins, DC, Chant, ADB, 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 2010, '10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis (ACST-1): A multicentre randomised trial', The Lancet, vol. 376, no. 9746, pp. 1074-1084. https://doi.org/10.1016/S0140-6736(10)61197-X
Halliday, Alison ; Harrison, Michael ; Hayter, Elizabeth ; Kong, Xiangling ; Mansfield, Averil ; Marro, Joanna ; Pan, Hongchao ; Peto, Richard ; Potter, John ; Rahimi, Kazem ; Rau, Angela ; Robertson, Steven ; Streifler, Jonathan ; Thomas, Dafydd ; Fraedrich, G. ; Schmidauer, C. ; Hölzenbein, T. H. ; Huk, I. ; Haumer, M. ; Kretschmer, G. ; Metz, V. ; Polterauer, P. ; Teufelsbauer, H. ; Cras, P. ; Hendriks, J. ; Lauwers, P. ; van Schil, P. ; de Souza, E. Barreto ; Emilio Dourado, M. ; Gurgel, G. ; Myrian Rocha, G. ; Petrov, V. ; Slabakov, G. ; Cooper, M. E. ; Gubitz, G. ; Holness, R. ; Howes, W. ; Langille, R. ; Legg, K. ; Nearing, S. ; MacKean, G. ; MacKay, M. ; Phillips, S. J. ; Sullivan, J. ; Wood, J. ; Erdelez, L. ; Sosa, T. ; Angelides, N. S. ; Christopoulos, G. ; Malikidou, A. ; Pesta, A. ; Ambler, Z. ; Mracek, J. ; Polivka, J. ; Rohan, V. ; Sevcik, P. ; Simaná, J. ; Beneš, V. ; Kramár, F. ; Kaste, M. ; Lepäntalo, M. ; Soinne, L. ; Cardon, J. M. ; Legalou, A. ; Gengenbach, B. ; Pfadenhauer, K. ; Wölfle, K. D. ; Flessenkämper, I. ; Klumpp, B. F. ; Marsch, J. ; Kolvenbach, R. ; Pfeiffer, T. ; Sandmann, W. ; Beyersdorf, F. ; Hetzel, A. ; Sarai, K. ; Schöllhorn, J. ; Spillner, G. ; Lutz, H. J. ; Böckler, D. ; Maeder, N. ; Busse, O. ; Grönniger, J. ; Haukamp, F. ; Balzer, K. ; Knoob, H. G. ; Roedig, G. ; Virreira, L. ; Franke, S. ; Moll, R. ; Schneider, J. ; Dayantas, J. ; Sechas, M. N. ; 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, A. ; Streifler, J. Y. ; Tabachnik, S. ; Zelikovski, A. ; Angiletta, D. ; Federico, F. ; Impedovo, G. ; Marotta, V. ; Pascazio, L. ; Regina, G. ; Andreoli, A. ; Pozzati, E. ; Bonardelli, S. ; Giulini, S. M. ; 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, P. G. ; 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. ; Alò, F. P. ; Bartolini, M. ; Carbonari, L. ; Caporelli, S. ; Grili-Cicilioni, C. ; Lagalla, G. ; Ioannidis, G. ; Pagliariccio, G. ; Silvestrini, M. ; 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, M. J. ; Holdaway, C. ; Muthu, S. ; Shakibaie, F. ; Vasudevan, T. M. ; Kroese, A. ; Slagsvold, C. E. ; Dahl, T. ; Johnsen, H. J. ; Lange, C. ; Myhre, H. O. ; Gniadek, J. ; Andziak, P. ; Elwertowski, M. ; Leszczynski, J. ; Malek, A. K. ; Mieszkowski, J. ; Noszczyk, W. ; Szostek, M. ; Toutounchi, S. ; Correia, C. ; Pereira, M. C. ; Akchurin, R. S. ; Flis, V. ; Miksic, K. ; Stirn, B. ; Tetickovic, E. ; Cairols, M. ; Capdevila, J. M. ; Iborra-Ortega, E. ; Obach, V. ; Riambau, V. ; Vidal-Barraquer, F. ; Vila-Coll, R. ; Diaz-Vidal, E. ; Iglesias-Negreia, J. I. ; Tovar-Pardo, A. ; Segura Iglesias, R. J. ; Alfageme, A. F. ; Barba-Velez, A. ; Estallo-Laliena, L. ; Garcia-Monco, J. C. ; Rodriguez Gonzalez, L. ; Corominas, C. ; Julia, J. ; Lozano, P. ; Marti-Masso, J. F. ; Porta, R. M. ; Rosendo Carrera, A. ; Gomez, J. ; Blomstrand, C. ; Gelin, J. ; Holm, J. ; Karlström, L. ; Mattsson, E. ; Bornhov, S. ; Dahlstrom, J. ; de Pedis, G. ; Jensen, S. M. ; Pärsson, H. ; Plate, G. ; Qvarfordt, P. ; Arvidsson, B. ; Brattström, L. ; Forssell, C. ; Potemkowski, A. ; Skiöldebrand, C. ; Stoor, P. ; Blomqvist, M. ; Calander, M. ; Forssell, C. ; Lundgren, F. ; Almqvist, H. ; Norgren, L. ; Norrving, B. ; Ribbe, E. ; Thörne, J. ; Gottsäter, A. ; Mätzsch, T. ; Nilsson, M. E. ; Forssell, C. ; Lonsson, M. ; Lundgren, F. ; Stahre, B. ; Norgren, L. ; Stenberg, B. ; Konrad, P. ; Jarl, L. ; Lundqvist, L. ; Olofsson, P. ; Rosfors, S. ; Skiöldebrand, C. ; Swedenborg, J. ; Takolander, R. ; Bergqvist, D. ; Ljungman, C. ; Pärsson, H. ; Kniemeyer, H. W. ; Widmer, M. K. ; 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, D. C. ; Sinnige, H. A W ; Yo, T. I. ; de Borst, G. J. ; Eikelboom, B. C. ; Kappelle, L. J. ; Moll, F. ; van Reedt Dortland, R. W H ; Westra, T. E. ; Jaber, H. ; Manaa, J. ; Meftah, R. B. ; Nabil, B. R. ; Sraieb, T. ; Bateman, D. ; Budd, J. ; Horrocks, M. ; Kivela, M. ; Shaw, L. ; Walker, R. ; D'Sa, A. A B Barros ; Simms, M. ; Baird, R. ; Campbell, M. ; Cole, S. ; Ferguson, I. T. ; Lamont, P. ; Mitchell, D. ; Sassano, A. ; Smith, F. C T ; Blake, K. ; Kirkpatrick, P. J. ; Martin, P. ; Turner, C. ; Clegg, J. F. ; Crosley, M. ; Hall, J. ; de Cossart, L. ; Edwards, P. ; Fletcher, D. ; Rosser, S. ; McCollum, P. T. ; Davidson, D. ; Levison, R. ; Bradbury, A. W. ; Chalmers, R. T A ; Dennis, M. ; Murie, J. ; Ruckley, C. V. ; Sandercock, P. ; Campbell, W. B. ; Frankel, T. ; Gardner-Thorpe, C. ; Gutowski, N. ; Hardie, R. ; Honan, W. ; Niblett, P. ; Peters, A. ; Ridler, B. ; Thompson, J. F. ; Bone, I. ; Welch, G. ; Grocott, E. C. ; Overstall, P. ; Aldoori, M. I. ; Dafalla, B. E A ; Bryce, J. ; Clarke, C. ; McCollum, P. T. ; Ming, A. ; Wilkinson, A. R. ; Bamford, J. ; Berridge, D. ; Scott, J. ; Abbott, R. J. ; Naylor, R. ; Harris, P. ; Humphrey, P. ; Adiseshiah, M. ; Aukett, M. ; Baker, D. ; Bishop, C. C R ; Boutin, A. ; Brown, M. ; Burke, P. ; Burnand, K. G. ; Colchester, A. ; Coward, L. ; Davies, A. H. ; Espasandin, M. ; Giddings, A. E B ; Hamilton, G. ; Judge, C. ; Kakkos, S. ; McGuiness, C. ; Morris-Vincent, P. ; Nicolaides, A. ; Padayachee, T. S. ; Riordan, H. ; Sullivan, E. ; Taylor, P. ; Thompson, M. ; Wolfe, J. H N ; McCollum, C. N. ; O'Neill, P. A. ; Welsh, S. ; Barnes, J. ; Cleland, P. ; Davis, M. ; Gholkar, A. ; Jones, R. ; Jaykishnam, V. ; Mendelow, A. D. ; O'Connell, J. E. ; Siddique, M. S S ; Stansby, G. ; Vivar, R. ; Ashley, S. ; Cosgrove, C. ; Gibson, J. ; Wilkins, D. C. ; Chant, A. D B ; Frankel, J. ; Shearman, C. P. ; Williams, J. ; Hall, G. ; Holdsworth, R. ; Davies, J. N. ; McLean, B. ; Woodburn, K. R. ; Brown, G. ; Curley, P. ; Loizou, L. ; Chaturvedi, Seemant ; Diaz, F. ; Radak, D. ; Todorovic, P. R. ; 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, C. G. ; Radley, A. ; Richards, S. / 10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis (ACST-1) : A multicentre randomised trial. In: The Lancet. 2010 ; Vol. 376, No. 9746. pp. 1074-1084.
@article{b96cee56fd034d99b0b56367f79b020a,
title = "10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis (ACST-1): A multicentre randomised trial",
abstract = "Background 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 long-term 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 indefinite 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",
author = "Alison Halliday and Michael Harrison and Elizabeth Hayter and Xiangling Kong and Averil Mansfield and Joanna Marro and Hongchao Pan and Richard Peto and John Potter and Kazem Rahimi and Angela Rau and Steven Robertson and Jonathan Streifler and Dafydd Thomas and G. Fraedrich and C. Schmidauer and H{\"o}lzenbein, {T. H.} and I. Huk and M. Haumer and G. Kretschmer and V. Metz and P. Polterauer and H. Teufelsbauer and P. Cras and J. Hendriks and P. Lauwers and {van Schil}, P. and {de Souza}, {E. Barreto} and {Emilio Dourado}, M. and G. Gurgel and {Myrian Rocha}, G. and V. Petrov and G. Slabakov and Cooper, {M. E.} and G. Gubitz and R. Holness and W. Howes and R. Langille and K. Legg and S. Nearing and G. MacKean and M. MacKay and Phillips, {S. J.} and J. Sullivan and J. Wood and L. Erdelez and T. Sosa and Angelides, {N. S.} and G. Christopoulos and A. Malikidou and A. Pesta and Z. Ambler and J. Mracek and J. Polivka and V. Rohan and P. Sevcik and J. Siman{\'a} and V. Beneš and F. Kram{\'a}r and M. Kaste and M. Lep{\"a}ntalo and L. Soinne and Cardon, {J. M.} and A. Legalou and B. Gengenbach and K. Pfadenhauer and W{\"o}lfle, {K. D.} and I. Flessenk{\"a}mper and Klumpp, {B. F.} and J. Marsch and R. Kolvenbach and T. Pfeiffer and W. Sandmann and F. Beyersdorf and A. Hetzel and K. Sarai and J. Sch{\"o}llhorn and G. Spillner and Lutz, {H. J.} and D. B{\"o}ckler and N. Maeder and O. Busse and J. Gr{\"o}nniger and F. Haukamp and K. Balzer and Knoob, {H. G.} and G. Roedig and L. Virreira and S. Franke and R. Moll and J. Schneider and J. Dayantas and Sechas, {M. N.} and S. Tsiaza and D. Kiskinis and A. Apor and C. Dzinich and L. Entz and K. H{\"u}ttl and Z. J{\`a}r{\`a}nyi and I. Mogan and Z. Nagy and A. Szabo and D. Varga and G. Juh{\'a}sz and L. M{\'a}ty{\'a}s and M. Hutchinson and D. Mehigan and Z. Aladjem and E. Harah and S. Elmakias and D. Gurvich and B. Yoffe and H. Ben-Meir and L. Dagan and R. Karmeli and G. Keren and A. Shimony and B. Weller and R. Avrahami and A. Koren and Streifler, {J. Y.} and S. Tabachnik and A. Zelikovski and D. Angiletta and F. Federico and G. Impedovo and V. Marotta and L. Pascazio and G. Regina and A. Andreoli and E. Pozzati and S. Bonardelli and Giulini, {S. M.} and B. Guarneri and P. Caiazzo and F. Mascoli and G. Becchi and R. Masini and E. Santoro and G. Simoni and M. Ventura and P. Scarpelli and C. Spartera and O. Arena and M. Collice and M. Puttini and F. Romani and I. Santilli and V. Segramora and R. Sterzi and G. Deriu and F. Verlato and Cao, {P. G.} and E. Cieri and {de Rango}, P. and L. Moggi and S. Ricci and A. Antico and F. Spigonardo and G. Malferrari and N. Tusini and E. Vecchiati and A. Cavallaro and H. Kasemi and M. Marino and E. Sbarigia and F. Speziale and N. Zinicola and Al{\`o}, {F. P.} and M. Bartolini and L. Carbonari and S. Caporelli and C. Grili-Cicilioni and G. Lagalla and G. Ioannidis and G. Pagliariccio and M. Silvestrini and D. Palombo and F. Peinetti and R. Adovasio and F. Chiodo-Grandi and G. Mase and F. Zamolo and V. Fregonese and N. Gonano and L. Mozzon and R. Blair and J. Chuen and D. Ferrar and M. Garbowski and Hamilton, {M. J.} and C. Holdaway and S. Muthu and F. Shakibaie and Vasudevan, {T. M.} and A. Kroese and Slagsvold, {C. E.} and T. Dahl and Johnsen, {H. J.} and C. Lange and Myhre, {H. O.} and J. Gniadek and P. Andziak and M. Elwertowski and J. Leszczynski and Malek, {A. K.} and J. Mieszkowski and W. Noszczyk and M. Szostek and S. Toutounchi and C. Correia and Pereira, {M. C.} and Akchurin, {R. S.} and V. Flis and K. Miksic and B. Stirn and E. Tetickovic and M. Cairols and Capdevila, {J. M.} and E. Iborra-Ortega and V. Obach and V. Riambau and F. Vidal-Barraquer and R. Vila-Coll and E. Diaz-Vidal and Iglesias-Negreia, {J. I.} and A. Tovar-Pardo and {Segura Iglesias}, {R. J.} and Alfageme, {A. F.} and A. Barba-Velez and L. Estallo-Laliena and Garcia-Monco, {J. C.} and {Rodriguez Gonzalez}, L. and C. Corominas and J. Julia and P. Lozano and Marti-Masso, {J. F.} and Porta, {R. M.} and {Rosendo Carrera}, A. and J. Gomez and C. Blomstrand and J. Gelin and J. Holm and L. Karlstr{\"o}m and E. Mattsson and S. Bornhov and J. Dahlstrom and {de Pedis}, G. and Jensen, {S. M.} and H. P{\"a}rsson and G. Plate and P. Qvarfordt and B. Arvidsson and L. Brattstr{\"o}m and C. Forssell and A. Potemkowski and C. Ski{\"o}ldebrand and P. Stoor and M. Blomqvist and M. Calander and C. Forssell and F. Lundgren and H. Almqvist and L. Norgren and B. Norrving and E. Ribbe and J. Th{\"o}rne and A. Gotts{\"a}ter and T. M{\"a}tzsch and Nilsson, {M. E.} and C. Forssell and M. Lonsson and F. Lundgren and B. Stahre and L. Norgren and B. Stenberg and P. Konrad and L. Jarl and L. Lundqvist and P. Olofsson and S. Rosfors and C. Ski{\"o}ldebrand and J. Swedenborg and R. Takolander and D. Bergqvist and C. Ljungman and H. P{\"a}rsson and Kniemeyer, {H. W.} and Widmer, {M. K.} and R. Kuster and R. Kaiser and W. Nagel and D. Sege and B. Weder and {de Nie}, J. and J. Doelman and N. Yilmaz and J. Buth and G. Stultiens and J. Boiten and A. Boon and {van der Linden}, F. and Busman, {D. C.} and Sinnige, {H. A W} and Yo, {T. I.} and {de Borst}, {G. J.} and Eikelboom, {B. C.} and Kappelle, {L. J.} and F. Moll and {van Reedt Dortland}, {R. W H} and Westra, {T. E.} and H. Jaber and J. Manaa and Meftah, {R. B.} and Nabil, {B. R.} and T. Sraieb and D. Bateman and J. Budd and M. Horrocks and M. Kivela and L. Shaw and R. Walker and D'Sa, {A. A B Barros} and M. Simms and R. Baird and M. Campbell and S. Cole and Ferguson, {I. T.} and P. Lamont and D. Mitchell and A. Sassano and Smith, {F. C T} and K. Blake and Kirkpatrick, {P. J.} and P. Martin and C. Turner and Clegg, {J. F.} and M. Crosley and J. Hall and {de Cossart}, L. and P. Edwards and D. Fletcher and S. Rosser and McCollum, {P. T.} and D. Davidson and R. Levison and Bradbury, {A. W.} and Chalmers, {R. T A} and M. Dennis and J. Murie and Ruckley, {C. V.} and P. Sandercock and Campbell, {W. B.} and T. Frankel and C. Gardner-Thorpe and N. Gutowski and R. Hardie and W. Honan and P. Niblett and A. Peters and B. Ridler and Thompson, {J. F.} and I. Bone and G. Welch and Grocott, {E. C.} and P. Overstall and Aldoori, {M. I.} and Dafalla, {B. E A} and J. Bryce and C. Clarke and McCollum, {P. T.} and A. Ming and Wilkinson, {A. R.} and J. Bamford and D. Berridge and J. Scott and Abbott, {R. J.} and R. Naylor and P. Harris and P. Humphrey and M. Adiseshiah and M. Aukett and D. Baker and Bishop, {C. C R} and A. Boutin and M. Brown and P. Burke and Burnand, {K. G.} and A. Colchester and L. Coward and Davies, {A. H.} and M. Espasandin and Giddings, {A. E B} and G. Hamilton and C. Judge and S. Kakkos and C. McGuiness and P. Morris-Vincent and A. Nicolaides and Padayachee, {T. S.} and H. Riordan and E. Sullivan and P. Taylor and M. Thompson and Wolfe, {J. H N} and McCollum, {C. N.} and O'Neill, {P. A.} and S. Welsh and J. Barnes and P. Cleland and M. Davis and A. Gholkar and R. Jones and V. Jaykishnam and Mendelow, {A. D.} and O'Connell, {J. E.} and Siddique, {M. S S} and G. Stansby and R. Vivar and S. Ashley and C. Cosgrove and J. Gibson and Wilkins, {D. C.} and Chant, {A. D B} and J. Frankel and Shearman, {C. P.} and J. Williams and G. Hall and R. Holdsworth and Davies, {J. N.} and B. McLean and Woodburn, {K. R.} and G. Brown and P. Curley and L. Loizou and Seemant Chaturvedi and F. Diaz and D. Radak and Todorovic, {P. R.} and D. Kamugasha and A. Baxter and C. Berry and J. Burrett and R. Collins and J. Crowther and C. Davies and B. Farrell and J. Godwin and R. Gray and C. Harwood and L. Hirt and C. Hope and S. Knight and M. Lay and A. Munday and A. Murawska and Peto, {C. G.} and A. Radley and S. Richards",
year = "2010",
month = "9",
day = "25",
doi = "10.1016/S0140-6736(10)61197-X",
language = "English (US)",
volume = "376",
pages = "1074--1084",
journal = "The Lancet",
issn = "0140-6736",
publisher = "Elsevier Limited",
number = "9746",

}

TY - JOUR

T1 - 10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis (ACST-1)

T2 - A multicentre randomised trial

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AU - Kaiser, R.

AU - Nagel, W.

AU - Sege, D.

AU - Weder, B.

AU - de Nie, J.

AU - Doelman, J.

AU - Yilmaz, N.

AU - Buth, J.

AU - Stultiens, G.

AU - Boiten, J.

AU - Boon, A.

AU - van der Linden, F.

AU - Busman, D. C.

AU - Sinnige, H. A W

AU - Yo, T. I.

AU - de Borst, G. J.

AU - Eikelboom, B. C.

AU - Kappelle, L. J.

AU - Moll, F.

AU - van Reedt Dortland, R. W H

AU - Westra, T. E.

AU - Jaber, H.

AU - Manaa, J.

AU - Meftah, R. B.

AU - Nabil, B. R.

AU - Sraieb, T.

AU - Bateman, D.

AU - Budd, J.

AU - Horrocks, M.

AU - Kivela, M.

AU - Shaw, L.

AU - Walker, R.

AU - D'Sa, A. A B Barros

AU - Simms, M.

AU - Baird, R.

AU - Campbell, M.

AU - Cole, S.

AU - Ferguson, I. T.

AU - Lamont, P.

AU - Mitchell, D.

AU - Sassano, A.

AU - Smith, F. C T

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AU - Kirkpatrick, P. J.

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AU - Clarke, C.

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AU - Bamford, J.

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AU - Humphrey, P.

AU - Adiseshiah, M.

AU - Aukett, M.

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AU - Bishop, C. C R

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AU - Brown, M.

AU - Burke, P.

AU - Burnand, K. G.

AU - Colchester, A.

AU - Coward, L.

AU - Davies, A. H.

AU - Espasandin, M.

AU - Giddings, A. E B

AU - Hamilton, G.

AU - Judge, C.

AU - Kakkos, S.

AU - McGuiness, C.

AU - Morris-Vincent, P.

AU - Nicolaides, A.

AU - Padayachee, T. S.

AU - Riordan, H.

AU - Sullivan, E.

AU - Taylor, P.

AU - Thompson, M.

AU - Wolfe, J. H N

AU - McCollum, C. N.

AU - O'Neill, P. A.

AU - Welsh, S.

AU - Barnes, J.

AU - Cleland, P.

AU - Davis, M.

AU - Gholkar, A.

AU - Jones, R.

AU - Jaykishnam, V.

AU - Mendelow, A. D.

AU - O'Connell, J. E.

AU - Siddique, M. S S

AU - Stansby, G.

AU - Vivar, R.

AU - Ashley, S.

AU - Cosgrove, C.

AU - Gibson, J.

AU - Wilkins, D. C.

AU - Chant, A. D B

AU - Frankel, J.

AU - Shearman, C. P.

AU - Williams, J.

AU - Hall, G.

AU - Holdsworth, R.

AU - Davies, J. N.

AU - McLean, B.

AU - Woodburn, K. R.

AU - Brown, G.

AU - Curley, P.

AU - Loizou, L.

AU - Chaturvedi, Seemant

AU - Diaz, F.

AU - Radak, D.

AU - Todorovic, P. R.

AU - Kamugasha, D.

AU - Baxter, A.

AU - Berry, C.

AU - Burrett, J.

AU - Collins, R.

AU - Crowther, J.

AU - Davies, C.

AU - Farrell, B.

AU - Godwin, J.

AU - Gray, R.

AU - Harwood, C.

AU - Hirt, L.

AU - Hope, C.

AU - Knight, S.

AU - Lay, M.

AU - Munday, A.

AU - Murawska, A.

AU - Peto, C. G.

AU - Radley, A.

AU - Richards, S.

PY - 2010/9/25

Y1 - 2010/9/25

N2 - Background 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 long-term 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 indefinite 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

AB - Background 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 long-term 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 indefinite 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

UR - http://www.scopus.com/inward/record.url?scp=77957189028&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77957189028&partnerID=8YFLogxK

U2 - 10.1016/S0140-6736(10)61197-X

DO - 10.1016/S0140-6736(10)61197-X

M3 - Article

C2 - 20870099

AN - SCOPUS:77957189028

VL - 376

SP - 1074

EP - 1084

JO - The Lancet

JF - The Lancet

SN - 0140-6736

IS - 9746

ER -