Why the study?
Does carotid endarterectomy reduce the risk of stroke in patients with carotid artery stenosis, and what factors identify candidates at high risk for stroke and low risk for perioperative complications?
Does carotid endarterectomy reduce the risk of stroke in patients with carotid artery stenosis, and what factors identify candidates at high risk for stroke and low risk for perioperative complications?
This review highlights clinical and radiological factors from major trials to help select optimal candidates for carotid endarterectomy by balancing stroke risk reduction against perioperative complications.
May refine CEA candidate selection from historical subgroups; leaves open validation in contemporary practice.
DESPITE EVIDENCE OF the efficacy of carotid endarterectomy from the large randomized multicenter trials completed in the 1990s, the physician who treats patients with carotid artery stenosis still is faced with a difficult management decision. More recently, subgroup analyses have been conducted of asymptomatic and symptomatic patients enrolled in these trials to identify clinical and radiological factors that increase the rates of morbidity and mortality associated with surgery, as well as those that increase the risk of stroke without surgery. Knowledge of these factors is important to recommend the best course of action for the individual patient. In this article, we summarize the conclusions of some of the subgroup analyses from the major carotid endarterectomy trials.
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Lanzino et al. (2001) studied this question.
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