(Stroke. 1999;30:1751-1758.)
© 1999 American Heart Association, Inc.
Original Contributions |
The North American Symptomatic Carotid Endarterectomy Trial
Surgical Results in 1415 Patients
From the John P. Robarts Research Institute, London, Ontario, Canada (G.G.F., M.E., J.W.F., H.J.M.B.); Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada (G.G.F., M.E., H.W.K.B., V.C.H., H.J.M.B.); Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada (M.E.); Department of Surgery, University of Texas Southwestern Medical Center, Dallas (G.P.C.); Department of Surgery, University of Arkansas for Medical Sciences, Little Rock (R.W.B.); Department of Surgery, University of Toronto, Toronto, Ontario, Canada (M.C.W.); and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (D.W.T., R.B.H.).
Correspondence to Gary G. Ferguson, MD, c/o NASCET, The John P. Robarts Research Institute, PO Box 5015, 100 Perth Dr, London, Ontario, Canada N6A 5K8. E-mail gary.ferguson{at}lhsc.on.ca
Background and Purpose—This study reports the surgical results in those patients who underwent carotid endarterectomy in the North American Symptomatic Carotid Endarterectomy Trial (NASCET).
Methods—The rates of perioperative stroke and death at 30 days and the final assessment of stroke severity at 90 days were calculated. Regression modeling was used to identify variables that increased or decreased perioperative risk. Nonoutcome surgical complications were summarized. The durability of carotid endarterectomy was examined.
Results—In 1415 patients there were 92 perioperative outcome events, for an overall rate of 6.5%. At 30 days the results were as follows: death, 1.1%; disabling stroke, 1.8%; and nondisabling stroke, 3.7%. At 90 days, because of improvement in the neurological status of patients judged to have been disabled at 30 days, the results were as follows: death, 1.1%; disabling stroke, 0.9%; and nondisabling stroke, 4.5%. Thirty events occurred intraoperatively; 62 were delayed. Most strokes resulted from thromboembolism. Five baseline variables were predictive of increased surgical risk: hemispheric versus retinal transient ischemic attack as the qualifying event, left-sided procedure, contralateral carotid occlusion, ipsilateral ischemic lesion on CT scan, and irregular or ulcerated ipsilateral plaque. History of coronary artery disease with prior cardiac procedure was associated with reduced risk. The risk of perioperative wound complications was 9.3%, and that of cranial nerve injuries was 8.6%; most were of mild severity. At 8 years, the risk of disabling ipsilateral stroke was 5.7%, and that of any ipsilateral stroke was 17.1%.
Conclusions—The overall rate of perioperative stroke and death was 6.5%, but the rate of permanently disabling stroke and death was only 2.0%. Other surgical complications were rarely clinically important. Carotid endarterectomy is a durable procedure.
Key Words: carotid endarterectomy • complications • risk factors
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