UCL Division of Surgery and Interventional Science


The Stroke Association Awards Funding for ECST-2

The Stroke Association

9 April 2014

The Stroke Association has awarded £209,611 to the Second European Carotid Surgery Trial (ECST-2), led by Martin Brown, Professor of Stroke Medicine at UCL and Consultant Neurologist at UCH, and co-led by the Division's own Toby Richards, Senior Clinical Lecturer and Consultant Vascular Surgeon.

ECST-2 builds on a previous UCL trial, the International Carotid Stenting Study (ICSS). ICSS compared Carotid Endarterectomy to Carotid Artery Stenting in recently symptomatic carotid stenosis. The ICSS trial results, in concordance with three other international trials, confirmed surgery to be the preferred method of treatment.

In the last decade, there have been significant advances in the management of artherosclerotic disease. Specifically with antihypertension management, antiplatelet and cholesterol lowering drugs, there has been a parallel reduced incidence of stroke in carotid artery disease. Similarly with specialisation of surgery, the operative risk of endarterectomy has fallen (currently 1.2%).

Analysis of data from previous trials in symptomatic or asymptomatic patients with carotid artery disease has enabled a risk stratification model to identify those patients who are at low risk of stroke, in whom there is now an equipoise on appropriateness of treatment.

ECST-2 is a multicentre, randomised, controlled, open, prospective clinical trial with blinded outcome adjudication. Suitable patients will be randomly allocated in equal proportions to be treated either by immediate revascularisation with Optimised Medical Therapy (OMT) or by OMT alone (in the latter arm, revascularisation may be performed at a later stage if it becomes more clearly indicated). An interim analysis will be performed after recruitment and follow up of 320 patients to assess the safety of the treatment policies and inform the design and sample size calculations for the full trial, using MRI to determine rates of cerebral infarction and haemorrhage at 2 years, after randomisation.