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Stroke, Vol 22, 1229-1235, Copyright © 1991 by American Heart Association
BACKGROUND AND PURPOSE: The CASANOVA study (Carotid Artery Stenosis with
Asymptomatic Narrowing: Operation Versus Aspirin) is a multicenter trial in
410 patients with asymptomatic stenosis (50-90%) of the internal carotid
artery who were randomized after angiography. METHODS: In group A, 206
patients with unilateral and bilateral stenosis had surgery unilaterally or
bilaterally, respectively. In group B, 160 patients with unilateral
stenosis had no initial surgery, whereas those with bilateral stenosis had
surgery on the more affected side. Patients were operated on during the
3-year follow-up period if one of the following events occurred:
development of a stenosis exceeding 90%; development of a bilateral
internal carotid artery stenosis greater than 50% (operation on the more
affected side); transient ischemic attack in the region supplied by the
internal carotid artery, together with a stenosis of this artery greater
than 50%; development of an internal carotid stenosis greater than 50%
contralateral to the operated side or restenosis greater than 50% in group
A. All patients were treated with 330 mg acetylsalicylic acid and 75 mg
dipyridamole three times daily. The minimal follow-up was 3 years. End
points were ischemic neurologic deficit exceeding 24 hours or death due to
surgery or stroke. RESULTS: Altogether, 334 carotid endarterectomies were
performed. Complications of angiography and operation (6.9%) were included.
Statistical analysis found no significant difference in the number of
neurologic deficits and deaths between the two groups. CONCLUSIONS: Carotid
endarterectomy for asymptomatic patients with a stenosis of the internal
carotid artery of less than 90% is not recommended at this time except as
part of a controlled clinical trial. However, cases of higher grade
stenosis (greater than 90%) were excluded from this study and were referred
for operation. No conclusion can be rendered regarding the potential
benefit of endarterectomy in these higher risk categories.
ARTICLES
Carotid surgery versus medical therapy in asymptomatic carotid stenosis. The CASANOVA Study Group
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