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(Stroke. 2008;39:e18.)
© 2008 American Heart Association, Inc.

Letters to the Editor

Mortality Associated With Carotid Endarterectomy for Asymptomatic Stenosis

Director, Stroke Prevention Program, Sunrise Hospital and Medical Center, Las Vegas, Nev

To the Editor:

Kragsterman et al reported on the long-term survival after carotid endarterectomy for asymptomatic stenosis in a population-based study.¹ They state that the long-term survival from randomized trials is not yet available. We reported on the risk of death associated with asymptomatic carotid stenosis from the prospective randomized trial, VA Cooperative Study 167 on Asymptomatic Carotid Stenosis, in 1993.²

In our report, we studied the risk factors for mortality in 444 male patients. At entry to the trial, patients were judged to be healthy enough to be randomized to operative intervention and were judged to be free of any disease that would preclude a minimal 5-year life expectancy after randomization. Our patients were followed for an average of 4 years. Thirty-seven percent of patients died during the follow-up, whereas 10% experienced a stroke. The risk of death was the same for the operative and nonoperative groups. Multivariate analysis demonstrated that 3 risk factors were significantly associated with an increased risk of mortality: diabetes, abnormal ECG and claudication. Patients with 2 or 3 of these risk factors demonstrated 4-year mortality rates of 45% and 53% respectively. This was significantly higher than patients with none of these risks (odds ratio=2.95 and odds ratio=4.06 respectively).

The study by Kragsterman et al validates our finding that cardiac disease, diabetes and peripheral vascular disease are predictors of decreased long-term longevity. These studies are evidence that asymptomatic carotid stenosis is a marker for generalized vascular disease. At best, carotid endarterectomy for asymptomatic carotid stenosis is a local treatment for a generalized disease. The data from these studies tend to indicate that aggressive risk factor management, especially for patients with more than one of these risk factors, is a more important factor in long-term survival.

Acknowledgments

Disclosures

None.

References

1. Kragsterman B, Björck M, Lindbäck J, Bergqvist D, Pärsson H; Swedish Vascular Registry. Long-term survival after carotid endarterectomy for asymptomatic stenosis. Stroke. 2006; 37: 2886–2891.[Abstract/Free Full Text]

2. Cohen SN, Hobson RW, Weiss DG, Chimowitz MI; VA Cooperative Study 167 Group. Death associated with asymptomatic carotid stenosis: long term clinical evaluation. J Vasc Surg. 1993; 18: 1002–1009.[CrossRef][Medline] [Order article via Infotrieve]

This Article Extract Full Text (PDF) All Versions of this Article: 39/1/e18    most recent STROKEAHA.107.493783v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Cohen, S. N. Search for Related Content PubMed PubMed Citation Articles by Cohen, S. N.