(Stroke. 2000;31:2330.)
© 2000 American Heart Association, Inc.
Original Contributions |
Effect of Contralateral Occlusion on Long-Term Efficacy of Endarterectomy in the Asymptomatic Carotid Atherosclerosis Study (ACAS)
From the Department of Surgery, Division of Peripheral Vascular Surgery, Loyola University Medical Center, Stritch School of Medicine, Maywood, Ill (W.H.B.); Departments of Epidemiology and International Health (V.J.H.) and Biostatistics (G.H.), University of Alabama at Birmingham; and Stroke Research Center, Department of Neurology, Wake Forest University School of Medicine, Winston Salem, NC (J.F.T.).
Correspondence to Virginia J. Howard, Department of Epidemiology and International Health, University of Alabama at Birmingham, 1530 3rd Ave S, RPHB 210F, Birmingham, AL 35294-0022. E-mail vjhoward{at}uab.edu
Background and Purpose—The
Asymptomatic Carotid Atherosclerosis Study
(ACAS) established the effectiveness of prophylactic
carotid endarterectomy, for patients in good health
who had stenosis 
60%, if conducted by surgeons with a
surgical morbidity and mortality of <3%. This secondary
analysis was performed to determine whether the presence of
contralateral cervical carotid occlusion alters the efficacy of
asymptomatic ipsilateral carotid endarterectomy.
Methods—One hundred sixty-three participants who had a baseline contralateral occlusion documented by Doppler ultrasound (77 medical, 86 surgical) were compared with 1485 participants with a patent contralateral carotid artery (748 medical, 737 surgical) for the risk of a combined end point of perioperative (30-day) death or stroke or long-term (5-year) ipsilateral stroke.
Results—For those without contralateral occlusion, surgery was associated with a 6.7% absolute reduction in the 5-year risk (95% CI, 2.1% to 11.4%), while for those with a contralateral occlusion, surgery was associated with a 2.0% absolute increase in risk (95% CI, -9.3% to 5.2%), which was a statistically significant difference in the effect of surgery (P=0.047). This difference is primarily attributable to low long-term risk for medically managed patients with contralateral occlusion.
Conclusions—While this post hoc analysis should be interpreted with caution, the findings suggest that endarterectomy in asymptomatic subjects with contralateral occlusion provides no long-term benefit (and may be harmful) in preventing stroke and death. These findings were a result of the benign course of medically treated subjects.
Key Words: carotid artery diseases • carotid artery occlusion • carotid endarterectomy
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