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Introduction. ACST-2 is a large and simple stream-lined trial which aims to compare both the early hazards and long-term durability of carotid endarterectomy (CEA) versus carotid artery stenting (CAS) in asymptomatic patients with high-grade carotid artery stenosis. Methods. Patients are eligible for ACST-2 if they have a severe carotid artery stenosis and intervention is clearly indicated, with both CEA and CAS practicable, but where there is substantial uncertainty as to which intervention is best. Collaborating surgeons and stenters may use their usual techniques and any CE-marked devices are permitted. Results. ACST-2 aims to recruit several thousand patients by 2019. To date, over 1200 patients have been randomised by study collaborators working in 79 centres across 25 countries. Italy is the top recruiting country, followed by the UK and Sweden. Interim blinded analyses reveal a 1% rate of serious 30-day postprocedure complications (disabling stroke, myocardial infarction or death). Discussion. ACST-2 is the only trial designed to reliably compare the short-term hazards and long-term benefits of CEA versus CAS in asymptomatic patients, and it complements other carotid trials which compare intervention versus medical management (e.g. SPACE-2). If, as seems likely, these trials show benefit from carotid intervention in addition to contemporary medical management in selected patients, then whether to perform CEA or CAS will remain a highly relevant question, and one only ACST-2 can answer. The English full-text version of this article is available at SpringerLink (under "Supplemental"). © Springer-Verlag 2013.

Original publication




Journal article



Publication Date





626 - 632