European Carotid Surgery Trial ECST

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The ECST trial enrolled 3024 patients with a stroke or transient ischemic attack within 6 months. Regardless of percent internal carotid artery stenosis, patients were randomized to carotid endarterectomy or medical management. Although the risk of death or major stroke did not differ between treatment groups in the entire population, patients with a stenosis >80% had a lower event rate with surgery than with medical treatment (14.9% versus 26.5%, P=0.001). Importantly, the ECST trial used different criteria from NASCET for stenosis determination, and these criteria overestimate stenosis severity compared to NASCET criteria.