April 10, 1981JAMA104 citations
View Full PaperCarotid Artery Stenosis—Hemodynamic Significance and Clinical Course
Key Result
Carotid endarterectomy was associated with a lower incidence of stroke (1.9% vs 16.2%) and recurrent TIA (17.6% vs 39.2%) compared to nonoperative treatment in hemodynamically significant stenosis.
Study Design
Type
Cohort (n=215)
Structured PICO
Does carotid endarterectomy reduce stroke, recurrent TIA, and cerebrovascular death in patients with hemodynamically significant carotid stenosis compared to nonoperative treatment?
P
Population
215 patients with a history of stroke, TIA, or asymptomatic carotid bruit evaluated for hemodynamic significance of carotid artery stenosis.
E
Exposure
Carotid endarterectomy
C
Comparator
Nonoperative treatment
O
Outcome
Incidence of stroke, recurrent TIA, and cerebrovascular deathhard clinical
Carotid endarterectomy is associated with a substantially lower risk of stroke and recurrent TIA compared to nonoperative management in patients with hemodynamically significant carotid stenosis.
Main Result
Absolute Event Rate: 1.9% vs 16.2%
Abstract
Two hundred fifteen patients with a history of either stroke, transient ischemic attack (TIA), or asymptomatic carotid bruit underwent noninvasive carotid artery testing using oculopneumoplethysmography. Of patients with hemodynamically significant stenosis, 51 (40.8%) underwent endarterectomy, and 74 (59.2%) were treated nonoperatively. The incidence of stroke in the nonoperated group was 12/74 (16.2%) compared with only 1/51 (1.9%) in the operated group. Similarly, recurrent TIA occurred in 29/74 (39.2%) of the nonoperated group vs 9/51 (17.6%) of the operated. In nonhemodynamically significant carotid stenosis, the risk of cerebrovascular death and stroke was exceedingly low: 2/90 (2.2%). Patients with hemodynamically significant stenosis treated nonoperatively have a greater risk of cerebrovascular death, stroke, and TIA than patients treated with carotid endarterectomy. (JAMA1981;245:1438-1441)