6/28/23, 9:50 PM ECST Pathway Feedback Search Clinical Topics Home Studies ECST ECST Disease Disease Disease Acute ischemic stroke Carotid artery stenosis Transie Trial question What is the role of carotid endarterectomy in adult patients with carotid stenosis who experienced at least one ischemic vascular event in the distribution of one or both carotid arteries in the previous 6 months? Study design Multi-center Single blinded RCT Population Characteristics of study participants 28.0% female N = 3024 72.0% male 3024 patients (850 female, 2168 male) Inclusion criteria: adult patients with carotid stenosis with 1 ischemic vascular event in the distribution of one or both carotid arteries in the previous 6 months Key exclusion criteria: doctors reasonably certain surgery is indicated or not indicated, embolism from the heart to the brain or eye, or more severe disease of the distal than of the proximal ICA Interventions N=1811 carotid endarterectomy (within 1 year of randomization) N=1213 no routine surgical intervention (surgery to be avoided for as long as possible) Primary outcome Major stroke or death at 3 years, in patients with stenosis > 80% https://web.pathway.md/studies/recphn8udemEv8wp2 1/2 6/28/23, 9:50 PM ECST Pathway 26.5 % 26.5 19.9 % 14.9 13.3 % Significant increase 6.6 % NNH = 9 0.0 % Carotid endarterectomy No routine surgical intervention Significant increase in major stroke or death at 3 years, in patients with stenosis > 80% (14.9% vs. 26.5%; ARD 11.6, 95% CI 4.72 to 18.48) Conclusion In adult patients with carotid stenosis with 1 ischemic vascular event in the distribution of one or both carotid arteries in the previous 6 months, carotid endarterectomy was superior to no routine surgical intervention with respect to major stroke or death at 3 years, in patients with stenosis > 80%. Reference European Carotid Surgery Trialists' Collaborative Group. Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet. 1998 May 9;351(9113):1379-87. Open reference URL https://web.pathway.md/studies/recphn8udemEv8wp2 2/2