Presentation is loading. Please wait.

Presentation is loading. Please wait.

Status Update from ACST-2

Published byRatna Sasmita Modified over 5 years ago

Similar presentations

Presentation on theme: "Status Update from ACST-2"— Presentation transcript:

1 Status Update from ACST-2
Alison Halliday Professor of Vascular Surgery University of Oxford LINC Tuesday 26th January 2016

2 Disclosure Alison Halliday I have no potential conflicts of interest to report:

3 15-20% ischaemic Strokes are caused by carotid stenosis 3

4 Rationale of ACST-2 – followed from our
first ACST-1 trial ( ) 4

5 Might intervention prevent stroke?
Asymptomatic carotid artery stenosis: narrowing that has not yet caused a stroke Might intervention prevent stroke?

6 ACST-1: CEA reduces 10-year stroke risk by 6-7%

7 With statins - same absolute benefit from surgery

8 ACST-1 – peri-operative risk reduced by statin therapy
4.3% 2.2%

9 Better procedural outcomes for CEA and CAS

10 Since ACST-1: Falling risks from CEA and CAS
Reduced procedural risk for CEA (Statins) Reduced procedural risks for CAS…

11 Falling risks from CEA and CAS
Reduced procedural risk for CEA (Statins) Reduced procedural risks for CAS…

12 Techniques, devices, experience have all
changed since the early symptomatic trials… Open vs closed-cell stent design Closed–cell safer?

13 Newer FLOW-reversal systems, direct puncture, membrane covered stents
Reduce emboli, early results now comparable to CEA

14 ACT-1 Abbott-funded (Xact + Emboshield), 3 CAS :1 CEA (88% of 1658 patients enrolled; stopped because slow) 5 year outcomes (88% alive) Any stroke % CAS vs 5% CEA Ipsi- stroke (non-procedural) 2.2% CAS vs 2.7% Any clinical re-intervention 1.6% CAS vs 3.3% (p=0.05) Conclusions : Lower enrollment reduced power but CAS is non-inferior to CEA up to 1 year, with similar 5-year results, and lower re-intervention rates

15 ACST-2 Status Update

16 Treatment for asymptomatic carotid artery stenosis:
surgery or stenting?

17 ACST-2: Overview First patient randomised: 2008
Some patients are now in their 8th year of follow up 113 Centres in 30 countries

18 ACST-2 Recruitment - last year at LINC
1694

19 ACST-2 Surgery vs Stenting Target 3600 patients
2061 today

20 ACST-2:CEA vs CAS Sex, Age, Co-morbidities: Men 70% Mean age 69 years Ischaemic heart disease 36% Diabetic 30% Renal impairment 6% Stroke risk factors: Atrial Fibrillation 6% Age >75 yrs 26% Previous stroke symptoms or infarct 43%

21 ACST-2: medical treatments
Yearly direct patient feedback (drug names and doses) At 2015 follow up Antithrombotic (aspirin, asasantin, clopidogrel, mono-dual APT, warfarin, NOAC) 96% BP Medications (1-3 named drugs, none) 84% Lipid-lowering (specific drugs/doses) 85%

22 ACST-2 Stents Protection Devices Type Wallstent Emboshield Filter
Cristallo Ideale Abbott Xact Filterwire Cordis Precise Mo. Ma Spider Prox occ Ev3 Protégé® RX Abbott RX Acculink Accunet AngioGuard Boston Adapt Sinus Gore Flow Reversal ViVEXX Twin One Distal balloon Roadsaver Inspire FiberNet Viatrac Zilver Mer (87% total)

23 ACST-2: Open vs Endovascular treatment
Blinded procedural outcomes for 1500 patients Disabling stroke/death CEA/CAS ACST-2: 1.0% Lower than for CEA in ACST-1: 1.7%

24 Recruitment plan Feb 2008 – Dec 2019

25 ACST-2 A very European Trial – Join us and create the future evidence!

Download ppt "Status Update from ACST-2"

Similar presentations

Alison Halliday, Professor of Vascular Surgery, University of Oxford 4 th April 2013 Trial update – 1169 Patients so far- Well done, what’s next? 1.

Alison Halliday, Professor of Vascular Surgery, University of Oxford 4 th April 2013 Trial update – 1169 Patients so far- Well done, what’s next? 1.
Preventing Strokes One at a Time Acute Interventions and Management 2009.

Preventing Strokes One at a Time Acute Interventions and Management 2009.
ECST-2: An update Martin M Brown Professor of Stroke Medicine UCL Institute of Neurology Queen Square, London ACST-2 Collaborators.

ECST-2: An update Martin M Brown Professor of Stroke Medicine UCL Institute of Neurology Queen Square, London ACST-2 Collaborators.
ACST-2 Ophthalmic sub-study Athanasios D. Giannoukas MD, MSc(Lond.), PhD(Lond.), FEBVS Professor of Vascular Surgery Chairman, Dept. of Vascular Surgery,

ACST-2 Ophthalmic sub-study Athanasios D. Giannoukas MD, MSc(Lond.), PhD(Lond.), FEBVS Professor of Vascular Surgery Chairman, Dept. of Vascular Surgery,
Stroke Mark Sudlow Consultant and Senior Lecturer

Stroke Mark Sudlow Consultant and Senior Lecturer
Is Carotid Stenting an Option for Treatment of Carotid Stenosis? Joint Hospital Surgical Grand Round WH WONG Queen Mary Hospital.

Is Carotid Stenting an Option for Treatment of Carotid Stenosis? Joint Hospital Surgical Grand Round WH WONG Queen Mary Hospital.
Will Scotland become an Independent Country? Vote ‘YES’ for independence, ‘NO’ to remain in the UK.

Will Scotland become an Independent Country? Vote ‘YES’ for independence, ‘NO’ to remain in the UK.
? This project was funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme (project number 06/301/233) and.

? This project was funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme (project number 06/301/233) and.
Study by: Granger et al. NEJM, September 2011,Vol. 365. No. 11 Presented by: Amelia Crawford PA-S2 Apixaban versus Warfarin in Patients with Atrial Fibrillation.

Study by: Granger et al. NEJM, September 2011,Vol No. 11 Presented by: Amelia Crawford PA-S2 Apixaban versus Warfarin in Patients with Atrial Fibrillation.
Stenting and Angioplasty with Protection in Patients at High-Risk for Endarterectomy Presented by Jay Yadav, MD on behalf of the SAPPHIRE Investigators.

Stenting and Angioplasty with Protection in Patients at High-Risk for Endarterectomy Presented by Jay Yadav, MD on behalf of the SAPPHIRE Investigators.
Stenting with or without Protection in High-Risk Patients with Moderate to High-Grade Carotid Stenosis Presented at ACC 2003 Late Breaking Clinical Trials.

Stenting with or without Protection in High-Risk Patients with Moderate to High-Grade Carotid Stenosis Presented at ACC 2003 Late Breaking Clinical Trials.
Journal Club Ani Balmanoukian and Peter Benjamin November 9, 2006 Journal Club Ani Balmanoukian and Peter Benjamin November 9, 2006.

Journal Club Ani Balmanoukian and Peter Benjamin November 9, 2006 Journal Club Ani Balmanoukian and Peter Benjamin November 9, 2006.
Carotid Endarterectomy versus Stenting: Where do we stand today? Vascular Conference March 23, 2010.

Carotid Endarterectomy versus Stenting: Where do we stand today? Vascular Conference March 23, 2010.
Jonathan A. Edlow, MD, FACEP Transient Ischemic Attack Patient Update: The Optimal Management of Emergency Department Patients With Suspected Cerebral.

Jonathan A. Edlow, MD, FACEP Transient Ischemic Attack Patient Update: The Optimal Management of Emergency Department Patients With Suspected Cerebral.
Endovascular Management of Intracranial and Extracranial Atherosclerosis Rishi Gupta, MD Associate Professor of Neurology, Neurosurgery, and Radiology.

Endovascular Management of Intracranial and Extracranial Atherosclerosis Rishi Gupta, MD Associate Professor of Neurology, Neurosurgery, and Radiology.
Secondary prevention after a TIA or ischemic stroke.

Secondary prevention after a TIA or ischemic stroke.
What Is Peripheral Vascular Disease? Daniel B. Walsh, M.D. Professor of Surgery, Section of Vascular Surgery Vice-Chair, Department of Sugery Dartmouth-Hitchcock.

What Is Peripheral Vascular Disease? Daniel B. Walsh, M.D. Professor of Surgery, Section of Vascular Surgery Vice-Chair, Department of Sugery Dartmouth-Hitchcock.
Endarterectomy versus Stenting in Patients with Symptomatic Severe Carotid Stenosis Dr. Quan, Dr. Mirhashemi, Dr. Chiang N Engl J Med 2006; 355:1660-71.

Endarterectomy versus Stenting in Patients with Symptomatic Severe Carotid Stenosis Dr. Quan, Dr. Mirhashemi, Dr. Chiang N Engl J Med 2006; 355:
Epidemiology in HK  Stroke is major cause of morbidity and mortality around the world  4th cause of mortality in HK resulting in >3000 deaths every.

Epidemiology in HK  Stroke is major cause of morbidity and mortality around the world  4th cause of mortality in HK resulting in >3000 deaths every.
Atherosclerotic Disease of the Carotid Artery Atherosclerosis is a degenerative disease of the arteries resulting in plaques consisting of necrotic cells,

Atherosclerotic Disease of the Carotid Artery Atherosclerosis is a degenerative disease of the arteries resulting in plaques consisting of necrotic cells,

Similar presentations

Ads by Google