Why the study?
Does carotid endarterectomy provide benefit over medical therapy alone in patients with significant asymptomatic or symptomatic carotid artery stenosis?
Does carotid endarterectomy provide benefit over medical therapy alone in patients with significant asymptomatic or symptomatic carotid artery stenosis?
Carotid endarterectomy is indicated for asymptomatic patients with ≥60% stenosis and symptomatic patients with ≥50% stenosis when performed by surgeons with low complication rates.
May support CEA in low-risk settings; leaves open impact of contemporary medical therapy on net benefit.
Four randomized cooperative trials for asymptomatic carotid artery disease and three randomized cooperative trials of symptomatic carotid artery disease have been completed and published. There are now firm and proven indications for carotid artery reconstruction. Asymptomatic carotid artery disease with 60% or greater linear stenosis on angiography has been shown to be better treated with surgery than with medical therapy alone. For symptomatic patients, linear stenoses of 50% of greater have been shown to have a significant benefit with surgical treatment. All surgical recommendations are based on a morbidity/mortality of 3% or less for the individual surgeon.
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Christopher M. Loftus (1998) studied this question.
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