These tools will no longer be maintained as of December 31, 2024. Archived website can be found here. PubMed4Hh GitHub repository can be found here. Contact NLM Customer Service if you have questions.


Pubmed for Handhelds

PUBMED FOR HANDHELDS

Search MEDLINE/PubMed

  • Title: [Analysis of the results of the main randomized trials on carotid endarterectomy for asymptomatic internal carotid stenosis].
    Author: Van Damme H, Limet R.
    Journal: Rev Med Liege; 2005 Oct; 60(10):811-3. PubMed ID: 16358670.
    Abstract:
    The authors analyse the ACAS (1997-93) and ACST (1993-2003) trials, comparing the best medical therapy vs endarterectomy of an asymptomatic 60 % or more stenosis of the internal carotid artery. The ACAS trial does not reveal any benefit of surgery in preventing major stroke during follow-up (stroke rate 3.4% vs 6.02% in medical group, N.S.). Only by considering minor and major strokes together, a beneficial effect of carotid endarterectomy could be evidenced (5.9% stroke reduction at 5 years: 5.1% ipsilateral stroke at 5 years after surgery vs 11% stroke at 5 years under medical treatment). Indeed, following surgery, the stroke risk (ipsilateral) at 5 years attained 5,1% vs 11% following medical treatment of an asymptomatic internal carotid artery stenosis of 60-99%. The ACST trial, set up in 1993, aimed to assess the long-term result of carotid endarterectomy for asymptomatic 60-99% stenosis. Patients randomized for immediate surgery had a slightly more favorable outcome than those allocated to medical treatment. Absolute risk reduction of major stroke at 5 years was 2.5%. Overall, the benefit of operating an asymptomatic carotid artery stenosis is rather low (1% less stroke per year and less than 0.5% major stroke reduction per year). This positive result is obtained only if the operative stroke-death rate remains extremely low (<2.8%). The indication for operating asymptomatic carotid stenosis must be cautiously taken; age of the patient, degree of stenosis and surgeon's experience and results are to be considered.
    [Abstract] [Full Text] [Related] [New Search]