Interim data from ECST-2 trial challenges surgical guidelines for carotid stenosis
Dr. Paul Nederkoorn, MD, PhD, Amsterdam University Medical Centres, presents interim data from the 2nd European Carotid Surgery Trial (ECST-2) at the ESOC 2023 conference. The study aims to determine if patients with carotid stenosis ≥50% and a low to intermediate risk of stroke (based on Carotid Artery Risk score) benefit from additional carotid revascularization when treated with optimized medical therapy. The researchers hypothesized that surgery may not be necessary for all patients, considering the improvements in medical treatment over time. The trial, now in its second year, involves international investigators and aims to challenge the outdated guidelines for carotid surgery, which are based on studies from 20-30 years ago. The interim analysis includes data from 429 patients and shows that both groups, one receiving optimized medical treatment alone and the other with surgery added, had similar outcomes at the two-year mark. The surgery group had slightly more adverse events initially, but the event rates became comparable (about 10%) over time. The findings suggest that for patients with carotid stenosis and a low to medium risk of stroke, surgery may not provide additional benefits when compared to optimized medical treatment alone. However, longer follow-up and further analysis are required. The study also includes a sub-study analyzing imaging data in 240 patients to gain more insights. Overall, this study challenges the current practice of recommending surgery for all patients with carotid stenosis and emphasizes the need for personalized treatment decisions based on individual risk factors and imaging markers.
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