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.
Why the study?
Does carotid endarterectomy reduce stroke, recurrent TIA, and cerebrovascular death in patients with hemodynamically significant carotid stenosis compared to nonoperative treatment?
Cohort (n=215)
Does carotid endarterectomy reduce stroke, recurrent TIA, and cerebrovascular death in patients with hemodynamically significant carotid stenosis compared to nonoperative treatment?
Absolute Event Rate: 1.9% vs 16.2%
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.
Supports CEA evaluation in significant stenosis; hypothesis-generating and requires randomized confirmation before practice change.
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)
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Ronald W. Busuttil (1981) conducted a cohort in Carotid artery stenosis (n=215). Carotid endarterectomy vs. Nonoperative treatment was evaluated on Stroke. 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.