Carotid Endarterectomy and Stenting Timing: The CEST Trial

What this Trial Is About

This research aims to compare the safety and effectiveness of carotid artery revascularization performed within 48 hours versus after 14 days in patients with symptomatic carotid stenosis who have MRI-confirmed acute infarction in the affected blood vessel area. Carotid artery stenosis is a major cause of stroke, and timely revascularization combined with medication is important to prevent further strokes. Despite recommendations for early surgery, concerns about complications have limited early procedures in some regions. Participants will receive carotid endarterectomy (CEA) or carotid artery stenting (CAS) along with best medical treatment, including antiplatelet medications such as Aspirin combined with Clopidogrel or Ticagrelor before surgery. Those assigned to CEA will continue with single antiplatelet therapy after surgery, while those assigned to CAS will continue dual antiplatelet therapy for three months before switching to single therapy. One group will have the procedure within 48 hours after randomization, and the other group will have it 14 days later. During the study, participants will be closely monitored for strokes, heart attacks, deaths, and urgent revascularizations from randomization up to three months. Evaluations will include brain imaging, functional and health quality assessments, and recording hospital stays and costs. The study will also track adverse events and recovery progress to understand the best timing for surgical treatment in this patient group.

Carotid Endarterectomy and Stenting Timing