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  • Title: 4. Current status of operative treatment for asymptomatic carotid stenosis.
    Author: Towne JB, Hobson RW.
    Journal: Can J Surg; 1994 Apr; 37(2):128-34. PubMed ID: 8156465.
    Abstract:
    OBJECTIVE: To determine the natural history of asymptomatic carotid stenosis and the effect of prophylactic carotid surgery on neurologic morbidity and mortality. DESIGN: A prospective, randomized, cooperative study, with a mean follow-up of 47.9 months. SETTING: Ten Veterans Administration hospitals across the United States. PATIENTS: The study comprised 436 patients who were divided into two groups: group 1, patients with symptomatic unilateral carotid disease, who were treated with carotid endarterectomy, and had contralateral asymptomatic stenosis; group 2, patients with significant asymptomatic carotid disease. Carotid stenosis was confirmed by arteriography, which demonstrated at least 50% stenosis, measured by comparing the least transverse diameter of the stenosis on lateral arteriography. INTERVENTIONS: Ocular plethysmography, duplex scanning and arteriography; carotid endarterectomy and acetylsalicylic acid or acetylsalicylic acid alone. RESULTS: The 436 patients were randomized between nonoperative (medical) (233) and operative (surgical) (211 procedures on 203 patients) groups. In the surgical group, the 30-day mortality was 1.9% and the permanent neurologic morbidity was 2.4%, for a combined stroke and death rate of 4.3%. The incidence of neurologic events was 8% in the surgical group compared with 20.6% in the medical group, for an absolute reduction in risk of 12.6% (p < 0.001). CONCLUSION: Carotid endarterectomy, combined with optional medical management, can reduce the incidence of ipsilateral neurologic events in high-risk men with arteriographically confirmed asymptomatic carotid stenosis.
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