Carotid endarterectomy | Number needed to treat* | |||||
Recruitment period | No of patients | Population | Perioperative risk of any stroke and death | Risk of any stroke (including perioperative) and death | ||
ACAS8 | 1987–1993 | 1662 | Asymptomatic (never symptomatic) | 2.3% | 5 year: 5.1% (CEA) vs 11.0% (BMT) | 17 |
ACST-19 | 1993–2003 | 3120 | Asymptomatic (6 months or longer) | 3.1% | 5 year: 6.4% (CEA) vs 11.8% (BMT) | 19 |
Carotid artery stenting | Relative risk | |||||
SAPPHIRE13 | 2000–2002 | 334 | Symptomatic (97)/asymptomatic (237) | 5.5% (CAS) vs 8.4% (CEA), p=0.36‡ | 3 year: 21.4% (CAS) vs 29.2% (CEA)† | 0.74 (95% CI 0.47 to 1.14) |
CREST-114 | 2005–2008 | 2502 | Symptomatic (1321)/asymptomatic (1181) | 2.5% (CAS) vs 1.4% (CEA), p=0.15 | 10 year: 11.8% (CAS) vs 9.9% (CEA)† | 1.10 (95% CI 0.83 to 1.44) |
ACT-I15 | 2005–2013 | 1453 | Asymptomatic | 2.9% (CAS) vs 1.7% (CEA), p=0.33 | 5 year: 3.8% (CAS) vs 3.3% (CEA)† | 1.14 (95% CI 0.61 to 2.15) |
ACST-216 | 2008–2020 | 3625 | Asymptomatic | 3.7% (CAS) vs 2.7% (CEA), p=0.12 | 5 year: 5.3% (CAS) vs 4.5% (CEA) | 1.11 (95% CI 0.91 to 1.32) |
Transcarotid artery revascularization | ||||||
ROADSTER-119 | 2012–2014 | 141 | Symptomatic (36)/asymptomatic (105) | 2.8%‡ | No follow-up data | |
ROADSTER-220§ | 2015–2019 | 692 | Symptomatic (180)/asymptomatic (512) | 1.4% | No follow-up data |
All reported risks specifically pertain to asymptomatic patients except for the SAPPHIRE and ROADSTER-1 trials that report combined risk of asymptomatic and symptomatic populations.
*Number needed to treat to prevent one stroke.
†These trials include the incidence of myocardial infarction in addition to risk of any stroke and death.
‡The value represents numerical risk combined for both asymptomatic and symptomatic populations.
§Interim result of ongoing trial.
BMT, best medical therapy; CAS, carotid artery stenosis; CEA, carotid endarterectomy.