September 27, 2004Canadian Medical Association JournalOpen Access

Should people with asymptomatic carotid artery stenosis undergo endarterectomy for primary stroke prevention?

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Why the study?

Does immediate carotid endarterectomy reduce the risk of stroke in asymptomatic patients with carotid artery stenosis ≥60% compared to medical therapy?

Population

3,120 asymptomatic patients with carotid artery stenosis ≥60%. Patients with poor surgical risk or a cardiac…

Comparison

Immediate carotid endarterectomy (CE) vs Medical therapy and deferral of CE

Design

Review, randomly allocated

Follow-up

5 years

Authors

DGDavid J. GladstoneWestern University

Discussion

Member takes

Implication

May support immediate endarterectomy in select asymptomatic patients; leaves open durability versus contemporary medical therapy.

Structured PICO

Does immediate carotid endarterectomy reduce the risk of stroke in asymptomatic patients with carotid artery stenosis ≥60% compared to medical therapy?

Population

3,120 asymptomatic patients with carotid artery stenosis ≥60% (on ultrasound). Patients with poor surgical risk or a cardiac source of emboli were excluded.

Intervention

Immediate carotid endarterectomy (CE)

Comparator

Medical therapy and deferral of CE (medical treatment left to the discretion of the treating physician)

Outcome

Perioperative morbidity and mortality, and the incidence of nonperioperative strokehard clinical

Immediate carotid endarterectomy reduces the 5-year risk of stroke in asymptomatic patients with ≥60% carotid stenosis, but the absolute benefit is small and depends on low perioperative complication rates.

Limitations

Absolute benefit is small
Low surgical morbidity and mortality in the trial is difficult to achieve outside of a clinical trial
Carotid ultrasonography may misclassify the degree of stenosis

Cite This Study

David J. Gladstone (2004) studied this question.

synapsesocial.com/papers/6a763d7b59770ea2c0bcb393 https://doi.org/10.1503/cmaj.1041431

View Full Paper

Ask AI

Bookmark

Should people with asymptomatic carotid artery stenosis undergo endarterectomy for primary stroke prevention?

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

Should people with asymptomatic carotid artery stenosis undergo endarterectomy for primary stroke prevention?

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

Also Consider

Also Consider