Published online before print August 26, 2004, doi: 10.1161/01.STR.0000141706.50170.a7
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(Stroke. 2004;35:2425.)
© 2004 American Heart Association, Inc.
Emerging Therapies |
Carotid Endarterectomy for Asymptomatic Carotid Stenosis
Asymptomatic Carotid Surgery Trial
From the Stroke Prevention Research Unit (P.M.R.), University Department of Clinical Neurology, Radcliffe Infirmary, Oxford, UK; and the Department of Medicine (Neurology) (L.B.G.), Duke Center for Cerebrovascular Disease, Center for Clinical Health Policy Research, Duke University and Veterans Administration Medical Center, Durham, NC.
Correspondence to Professor P.M. Rothwell, Stroke Prevention Research Unit, University Department of Clinical Neurology, Radcliffe Infirmary, Woodstock Rd, Oxford OX2 6HE. E-mail peter.rothwell@clneuro.ox.ac.uk
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
Effective prevention is inarguably the best option for reducing the individual and societal burden of stroke. For each patient, clinicians balance the benefits of a given preventive therapy against its associated risks and costs. Where possible, these assessments should be based on the results of randomized clinical trials. Carotid endarterectomy (CEA), the most-commonly used surgical procedure to prevent stroke, has been subjected to several randomized trials. These underlie evidence-based guideline and consensus statements providing recommendations for its use.1–7 The evidence base for endarterectomy for symptomatic stenosis is considerable,8,9 but guidelines on surgery for asymptomatic stenosis have been largely based on the results of the Asymptomatic Carotid Atherosclerosis Study (ACAS)10 in conjunction with other smaller trials.11,12 Guidance differs from endorsement of the operation for selected patients (eg, based on patient age, life expectancy, concomitant illnesses, etc.) with varying degrees of asymptomatic stenosis (generally either 60% to 99% or 80% to 99%) in whom the procedure can be performed with low (ie, <3%) complication rates to advising that endarterectomy not be performed in patients without referable symptoms.
ACAS reported a 47% relative reduction in the risk of ipsilateral stroke and perioperative death in patients randomized to surgery despite a 5-year risk of ipsilateral stroke without the operation of only 11%.10 The results led to major increases in rates of endarterectomy for asymptomatic stenosis in some countries, most notably the United States. Of the approximate 150 000 endarterectomies performed in the United States each year, at least half are done for stenoses that
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