Key result
The post-ACAS period was associated with a significant decrease in stroke mortality among asymptomatic patients undergoing carotid endarterectomy compared to the pre-ACAS period (1.9% vs 4.3%, P<0.0005).
Why the study?
Did the publication of the ACAS study affect the volume and stroke/mortality outcomes of carotid endarterectomy?
Observational
Did the publication of the ACAS study affect the volume and stroke/mortality outcomes of carotid endarterectomy?
The publication of the ACAS study was associated with a tenfold increase in CEA volume and a significant improvement in stroke/mortality rates, particularly among asymptomatic patients.
Reduced asymptomatic CEA mortality post-ACAS supports trial influence on outcomes; leaves open whether publication directly drove volume and practice shifts.
Recent studies have demonstrated the benefits of carotid endarterectomy (CEA) and risk factor control in preventing stroke in asymptomatic patients. In this study, the effect of the asymptomatic carotid atherosclerosis study (ACAS) on the frequency of CEAs performed and the outcome of such procedures on symptomatic and asymptomatic patients were analyzed. From 1990 to 1996, all patients undergoing CEA were prospectively entered into a computerized vascular registry. The number of procedures, indications, demographics, and early and late results were analyzed and compared with similar data compiled prior to the ACAS study. The total volume of CEAs performed increased from 66 in 1990 to 719 in 1996 (ratio 1:12.3). The ratio of symptomatic to asymptomatic patients changed from 1.75:1 in 1990 to 1:1.52 in 1996. The combined stroke/mortality rate dropped from 4.75% in 1990 to 2.15% in 1996. The stroke mortality in the asymptomatic group decreased significantly from 4.3 to 1.9% in the pre and post-ACAS groups respectively (P<0.0005). The stroke mortality of symptomatic patients remained constant at 2.1 and 1.4% respectively.Since the completion of ACAS in 1993, the number of CEAs performed on our service has increased tenfold. An increase in volume has translated into an improved stroke/mortality rate and significantly decreased length of stay.
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R. Clement Darling (2000) conducted an observational in Carotid atherosclerosis. Post-ACAS period vs. Pre-ACAS period was evaluated on Stroke mortality in the asymptomatic group (p=<0.0005). The post-ACAS period was associated with a significant decrease in stroke mortality among asymptomatic patients undergoing carotid endarterectomy compared to the pre-ACAS period (1.9% vs 4.3%, P<0.0005).
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