Sökning: WFRF:(Peto Richard) > Second asymptomatic...
Fältnamn | Indikatorer | Metadata |
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000 | 05077naa a2200553 4500 | |
001 | oai:lup.lub.lu.se:9746f786-57d5-4b3b-ac29-0c845f376285 | |
003 | SwePub | |
008 | 230831s2021 | |||||||||||000 ||eng| | |
009 | oai:prod.swepub.kib.ki.se:147676785 | |
024 | 7 | a https://lup.lub.lu.se/record/9746f786-57d5-4b3b-ac29-0c845f3762852 URI |
024 | 7 | a https://doi.org/10.1016/S0140-6736(21)01910-32 DOI |
024 | 7 | a http://kipublications.ki.se/Default.aspx?queryparsed=id:1476767852 URI |
040 | a (SwePub)lud (SwePub)ki | |
041 | a engb eng | |
042 | 9 SwePub | |
072 | 7 | a art2 swepub-publicationtype |
072 | 7 | a ref2 swepub-contenttype |
100 | 1 | a Halliday, Alisonu University of Oxford4 aut |
245 | 1 0 | a Second asymptomatic carotid surgery trial (ACST-2) : a randomised comparison of carotid artery stenting versus carotid endarterectomy |
264 | 1 | c 2021 |
520 | a BACKGROUND: Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence.METHODS: ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362.FINDINGS: Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86-1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91-1·32; p=0·21).INTERPRETATION: Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable.FUNDING: UK Medical Research Council and Health Technology Assessment Programme. | |
650 | 7 | a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Kardiologi0 (SwePub)302062 hsv//swe |
650 | 7 | a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Cardiac and Cardiovascular Systems0 (SwePub)302062 hsv//eng |
653 | a Aged | |
653 | a Carotid Stenosis/surgery | |
653 | a Endarterectomy, Carotid/statistics & numerical data | |
653 | a Female | |
653 | a Humans | |
653 | a Male | |
653 | a Risk Factors | |
653 | a Stents/statistics & numerical data | |
653 | a Stroke/mortality | |
653 | a Time Factors | |
653 | a Treatment Outcome | |
700 | 1 | a Bulbulia, Richardu University of Oxford4 aut |
700 | 1 | a Bonati, Leo Hu University Hospital Basel4 aut |
700 | 1 | a Chester, Johannau University of Oxford4 aut |
700 | 1 | a Cradduck-Bamford, Andreau University of Oxford4 aut |
700 | 1 | a Peto, Richardu University of Oxford4 aut |
700 | 1 | a Pan, Hongchaou University of Oxford4 aut |
700 | 1 | a Gottsäter, Andersu Lund University,Lunds universitet,Vaskulära sjukdomar - kliniska studier,Forskargrupper vid Lunds universitet,Vascular Diseases - Clinical Research,Lund University Research Groups4 cre0 (Swepub:lu)medf-ago |
710 | 2 | a University of Oxfordb University Hospital Basel4 org |
710 | 2 | a ACST-2 Collaborative Group |
773 | 0 | t The Lancetg 398:10305, s. 1065-1073q 398:10305<1065-1073x 0140-6736 |
773 | 0 | t Lancet (London, England)g 398:10305, s. 1065-1073q 398:10305<1065-1073x 1474-547X |
856 | 4 | u http://dx.doi.org/10.1016/S0140-6736(21)01910-3x freey FULLTEXT |
856 | 4 8 | u https://lup.lub.lu.se/record/9746f786-57d5-4b3b-ac29-0c845f376285 |
856 | 4 8 | u https://doi.org/10.1016/S0140-6736(21)01910-3 |
856 | 4 8 | u http://kipublications.ki.se/Default.aspx?queryparsed=id:147676785 |
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