Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis

Article Abstract:

Carotid endarterectomy, surgical removal of the lining of a partially blocked carotid artery, which carries blood to the brain, is a procedure that has been performed on large numbers of patients to prevent stroke, sudden loss of blood supply to the brain. To learn more about the effectiveness this surgery, a randomized study at 50 medical centers was performed. Eligible patients had experienced a hemispheric transient ischemic attack (temporary interruption of blood flow to one side of the brain) or other specific temporary symptoms, within the previous 120 days, and who had blockage of between 70 percent and 99 percent of the internal carotid artery on the symptomatic side. Of the 659 patients who met these criteria, all received optimal medical care, including medication to reduce the formation of blood clots (antiplatelet medication). Approximately half the group (328 patients) also underwent carotid endarterectomy. The patients were followed-up for an average of 18 months to assess the frequency of strokes or deaths; they also underwent neurologic testing at regular intervals. Results showed a clear advantage for the group that underwent surgery; in fact, randomization was stopped at a preplanned point when the benefits of this approach became clear. The cumulative risk of having a stroke on the same side (ipsilateral) as the initial transient ischemic attack was 26 percent for the patients who received medical treatment only, and 9 percent in the surgically treated group. Rates for major or fatal ipsilateral strokes for the medical and surgical groups were 13.1 percent and 2.5 percent, respectively. In general, the advantages of surgery were less apparent for patients with less severe blockage. The results indicate that patients with transient ischemic attacks or minor strokes should be considered for inclusion in ongoing studies that focus on patients with moderate blockage. Patients with high-grade narrowing of the carotid artery, such as those studied in this report, should be referred to medical centers where optimal surgical results can be obtained. (Consumer Summary produced by Reliance Medical Information, Inc.)

Carotid artery diseases

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Efficacy of carotid endarterectomy for asymptomatic carotid stenosis

Article Abstract:

Carotid endarterectomy may reduce the overall incidence of cerebral ischemia, monocular blindness and stroke in patients with asymptomatic carotid stenosis. Carotid stenosis is a narrowing of the carotid artery, and endarterectomy is the surgical removal of the thickened tissue in the artery. Of 444 men with asymptomatic carotid stenosis, 233 patients took 650 milligrams (mg) of aspirin twice a day, and 211 took 650 mg of aspirin twice daily and underwent endarterectomy. Of the group undergoing surgery, 12.8% experienced a neurologic event - transient ischemic attack, monocular blindness or stroke - compared with 24.5% of the group taking aspirin. However, there was no significant difference between groups in the incidence of stroke alone or the combined incidence of stroke and death. Among both groups coronary atherosclerosis was the main cause of death.

Arteries, Arterial stenosis

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Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis

Article Abstract:

The use of the surgical procedure of carotid endarterectomy provides considerable future risk prevention against stroke in patients with severely narrowed arteries, but only moderate protection in those with moderate narrowing. Patients with severe carotid stenosis, a narrowing of more than 70%, seem to benefit considerably from the procedure, while rhose with a narrowing estiamted between 50% and 69% had only moderate benefit from the surgery. Patients who had a narrowing of less than 50% did not seem to have any benefit at all from the surgery.

Prevention, Stroke (Disease), Stroke

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