The Second European Carotid Surgery Trial (ECST-2)

This text summarizes interim results from the Second European Carotid Surgery Trial (ECST-2), a multicenter randomized trial comparing optimized medical therapy (OMT) alone versus OMT plus revascularization for patients with asymptomatic or low-to-intermediate risk symptomatic carotid stenosis of 50% or greater. The trial used the Carotid Artery Risk (CAR) score to identify patients predicted to have a 5-year stroke risk of less than 20%. The 2-year interim analysis, utilizing a hierarchical outcome and win ratio method, found no significant evidence that adding revascularization to OMT provided a benefit in this patient population. The study suggests that OMT alone might be sufficient for this group, but notes that longer-term 5-year data is needed for confirmation.