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November 12, 1998New England Journal of MedicineOpen Access

Benefit of Carotid Endarterectomy in Patients with Symptomatic Moderate or Severe Stenosis

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Why the study?

Does carotid endarterectomy reduce the risk of stroke in patients with symptomatic moderate or severe carotid stenosis?

Population

Patients with symptomatic carotid stenosis

Follow-up

eight years

Authors

HBHenry J.M. BarnettBoston UniversityDTD. Wayne TaylorCross-Cutting CardiologyMEMichael EliasziwPreventive Cardiology

Discussion

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Implication

May guide stenosis-based decisions in symptomatic disease; leaves open randomized confirmation for moderate stenosis.

Key Points

  • To evaluate the efficacy of carotid endarterectomy in reducing stroke risk among patients with symptomatic carotid stenosis of varying severity.
  • Evaluated patients with symptomatic carotid stenosis stratified by degree of narrowing: less than 50%, 50% to 69%, and 70% or greater.
  • Assessed surgical outcomes and stroke incidence over an eight-year follow-up period.
  • Patients with severe stenosis (≥70%) derived a durable, long-term reduction in stroke risk through eight years of follow-up.
  • Patients with moderate stenosis (50% to 69%) experienced only a moderate reduction in stroke risk, requiring consideration of recognized risk factors and exceptional surgical skill.
  • Patients with stenosis of less than 50% derived no therapeutic benefit from endarterectomy.

Structured PICO

Does carotid endarterectomy reduce the risk of stroke in patients with symptomatic moderate or severe carotid stenosis?

P
Population
Patients with symptomatic carotid stenosis (evaluated across <50%, 50-69% moderate, and ≥70% severe stenosis categories)
I
Intervention
Carotid endarterectomy
O
Outcome
Risk of strokehard clinical

Carotid endarterectomy provides durable stroke risk reduction in symptomatic patients with severe (≥70%) stenosis and moderate benefit in those with 50-69% stenosis, but no benefit for <50% stenosis.

Cite This Study

Barnett et al. (1998) studied this question.

synapsesocial.com/papers/69d7827ab843b2be9949026chttps://doi.org/10.1056/nejm199811123392002
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Also Consider

Synapse has enriched 4 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1The Appropriateness of Carotid Endarterectomy1988 · 493 citations
  2. 2An Analysis of Perioperative Surgical Mortality and Morbidity in the Asymptomatic Carotid Atherosclerosis Study1996 · 199 citations
  3. 3Further comments on the measurement of carotid stenosis from angiograms. North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group.1994 · 131 citations
  4. 4Carotid endarterectomy: does it work?1984 · 187 citations