The results were presented at the European Society of Cardiology Congress 2025 in Madrid, Spain, and will give doctors confidence in offering the procedure most suited to their patients.
Stroke is the third largest cause of death worldwide, responsible for over six million deaths each year. A common cause of stroke is carotid artery disease (also known as carotid artery stenosis), where the large blood vessels that supply oxygen to the brain become narrower. Usually, this is due to deposits of fatty material (atherosclerosis) in the arteries which eventually form hardened plaques, which can rupture, causing strokes.
Patients with carotid artery disease may undergo one of two different procedures to open up the affected artery and improve blood flow to the brain. Carotid artery surgery, also called carotid endarterectomy (CEA), involves surgically removing the plaque, and is more commonly performed. Alternatively, the artery may be opened by widening the narrowed artery with a balloon angioplasty, and then a stent added to permanently keep the walls open (carotid artery stenting, CAS).
The Asymptomatic Carotid Surgery Trial 2 (ACST-2) enrolled 3,624 participants from 33 countries. Each participant had been diagnosed with carotid artery disease that had not caused a stroke. Participants were randomly allocated to undergo either CAS or CEA, and followed for a median of eight and half years, with some participants followed for almost 20 years.
Read the full story on the Nuffield Department of Population Health website.