ArticlesRandomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST)*
Introduction
We designed the European Carotid Surgery Trial (ECST) as a randomised comparison of “carotid endarterectomy as soon as possible” with “avoid surgery if at all possible, for as long as possible” (ie, surgery versus control) in patients with one or more carotidterritory ischaemic episodes within the previous 6 months and with some degree of stenosis near the origin of the symptomatic internal carotid artery (ICA). From the outset we expected that the balance of surgical risk and benefit, in terms of the prevention of stroke, would vary among categories of patients, and in particular with severity of stenosis. This expectation was borne out by the interim results.1, 2 Now that trial recruitment and follow-up are complete, we can report in detail on the balance of surgical risk and benefit.
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Methods
We carried out the trial in 97 centres in 12 European countries and one centre in Australia and described much of the methodology in our first report.1 Ethical approval was obtained in all centres. Informed consent was obtained from each patient in accordance with the requirements of the local ethics committee.
Results
3024 patients received randomised treatment allocation— 1811 surgery and 1213 control (figure 1). The mean follow-up was 6·1 years (mean 6·1 years in the control group, 6·0 years in the surgery group; maximum 13·8 years). We lost only 25 patients (0·83%) to follow-up, six because of emigration. Because 19 of these 25 had at least some follow-up (mean 3·0 years for controls; 3·2 years for surgery group) we were able to include them in the analysis up until the time we lost them. Therefore, 3018
Discussion
The ECST has shown that for patients with recently symptomatic carotid stenosis, carotid endarterectomy carries a small but serious risk of stroke or death; that without surgery there is a substantial risk of stroke ipsilateral to a severely stenosed carotid artery, particularly in the first 2–3 years; and that most of the risk of ipsilateral stroke is abolished by successful surgery, so most of these strokes must be caused by embolism from, or low flow distal to, severe carotid stenosis. These
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Cited by (0)
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Writing committee, study organisation, and participants given at end of paper