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Carotid revascularization is often pursued in high-risk patients with asymptomatic carotid stenosis — that is, no recent history of transient ischemic attack or ipsilateral stroke — based on previous trials (JAMA 1995; 273:1421 and Stroke 2004; 35:2425) demonstrating reduced risk for stroke or death with carotid endarterectomy (CEA). Further studies found that carotid artery stenting (CAS) was noninferior to CEA in a population of asymptomatic and symptomatic patients in the long term, although CEA was better in patients older than 70 and CAS in younger ones (NEJM JW Neurol Oct 2012 and Lancet Neurol 2012; 11:755).
Researchers conducted ACT I, a 5-year, multicenter trial, to compare outcomes in asymptomatic patients with 70% to 99% carotid s…