Indications for endarterectomy in asymptomatic stenoses of the internal or common carotid artery--results of the North American ACAS Study
Mast, H.; Chambless, L.E.; Mohr, J.P.; Toole, J.F.
Zentralblatt für Chirurgie 121(12): 1033-1035
1996
ISSN/ISBN: 0044-409X PMID: 9092223 Document Number: 467357
To determine the effect of endarterectomy on the primary prevention of ischemic stroke in patients with asymptomatic carotid artery stenosis. In a prospective, randomized, multicenter trial 1659 patients with asymptomatic carotid stenosis of 60% or more were studied in two treatment arms (endarterectomy: n = 825; medical therapy: n = 834). Endpoints were: (1) ischemic stroke in the vascular territory of the study artery, (2) any perioperative stroke or any perioperative death. The Kaplan-Meier 5-year-risk estimation showed a relative risk reduction of 53% (confidence interval: 22%-72%) for patients in the surgical arm. The combined perioperative morbidity and mortality rate was 2.3%. Endarterectomy of asymptomatic carotid artery stenosis performed with a perioperative complication rate of less than 3% reduces the 5-year risk of ipsilateral stroke.