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The first Asymptomatic Carotid Surgery Trial (ACST-1) randomised 3120 patients with severe carotid artery narrowing (but no recent stroke) to CEA or medical therapy, and allocation to CEA halved long-term stroke risk. CEA may also help prevent vascular dementia, but this hypothesis has not previously been assessed in randomised studies.

With >15 years follow-up, ACST-1 provides a unique opportunity to compare dementia rates in over 1600 UK and Swedish patients (in whom data-linkage is possible)randomised to CEA vs medical therapy (ie, intention to treat analysis).

Incident dementia rates will be obtained from death certificates and routine electronic health records. Additionally, surviving participants (around 1000) will undergo cognitive assessment using several validated tools (eg, TICSM and IQCODE).

Mr Bulbulia, Dr Hongchao Pan and Professor Halliday are currently conducting ACST-2 (a trial comparing carotid surgery with stenting) and are members of The Carotid Stenosis Trialists Collaboration (CSTC), and the methods developed herein could be used in other carotid trials.

Research Experience, Research Methods and Training

How to use routine health care records in clinical research (including navigating regulatory, ethics and research governance barriers in the UK and Sweden); tools to assess cognitive impairment.

Specific training will be given in appropriate statistical techniques relevant to clinical trials.

Field Work, Secondments, Industry Placements and Training

Occasional travel to Sweden (Uppsala: Prof Björk and Wanheinen).


In addition to the supervisors noted above, this project will be co-supervised by Professor Alison Halliday of the Nuffield Department of Surgical Sciences.

Prospective Candidate

Doctors with an interest in Stroke Medicine, Vascular Surgery, Neurology ; Public Health trainees; Epidemiologists.