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ACST-1: Difference between revisions
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* Lipid-lowering therapy may have been suboptimal in the trial.<ref>Paraskevas KI, Mikhailidis DP, Veith FJ. Best medical treatment for a symptomatic carotid artery stenosis. ''Lancet''. 2011;377(9760):123; author reply 123-4</ref><!-- What criticisms exist about the paper? --> | * Lipid-lowering therapy may have been suboptimal in the trial.<ref>Paraskevas KI, Mikhailidis DP, Veith FJ. Best medical treatment for a symptomatic carotid artery stenosis. ''Lancet''. 2011;377(9760):123; author reply 123-4</ref><!-- What criticisms exist about the paper? --> | ||
* Ultrasound was used in the trial, which may be associated with its own imperfections as compared to modern imaging techniques, such as angiography.<ref name=":0">[http://www.ncbi.nlm.nih.gov/pubmed/15135590 Barnett HJ. Carotid endarterectomy. ''Lancet.'' 2004;364(9440):1122-3; author reply 1125-6.]</ref> | * Ultrasound was used in the trial, which may be associated with its own imperfections as compared to modern imaging techniques, such as angiography.<ref name=":0">[http://www.ncbi.nlm.nih.gov/pubmed/15135590 Barnett HJ. Carotid endarterectomy. ''Lancet.'' 2004;364(9440):1122-3; author reply 1125-6.]</ref> | ||
* Contemporary medical therapy has changed since the trial. Patients in the ACST did not receive best medical therapy as compared to modern practice.<ref | * Contemporary medical therapy has changed since the trial. Patients in the ACST did not receive best medical therapy as compared to modern practice.<ref name=":1" /> | ||
* Medical therapy was not standardized and left to the discretion of clinicians.<ref>[http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0066325/ Jonas DE, Feltner C, Amick HR, Sheridan S, Zheng ZJ, Watford DJ, ''et al.'' Screening for Asymptomatic Carotid Artery Stenosis: A Systematic Review and Meta-Analysis for the U.S. Preventive Services Task Force. Evidence Synthesis No. 111. AHRQ Publication No. 13-05178-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2014]</ref> | * Medical therapy was not standardized and left to the discretion of clinicians.<ref name=":1">[http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0066325/ Jonas DE, Feltner C, Amick HR, Sheridan S, Zheng ZJ, Watford DJ, ''et al.'' Screening for Asymptomatic Carotid Artery Stenosis: A Systematic Review and Meta-Analysis for the U.S. Preventive Services Task Force. Evidence Synthesis No. 111. AHRQ Publication No. 13-05178-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2014]</ref> | ||
* Surgeons in the trial were highly selected. It's important to consider if a comparable incidence of operative complications can be achieved in local centres.<ref name=":0" /> | * Surgeons in the trial were highly selected. It's important to consider if a comparable incidence of operative complications can be achieved in local centres.<ref name=":0" /> | ||