Effect of Contralateral Occlusion on Long-Term Efficacy of Endarterectomy in the Asymptomatic Carotid Atherosclerosis Study (ACAS)
Why the study?
Does prophylactic carotid endarterectomy reduce the risk of stroke or death in patients with asymptomatic carotid atherosclerosis and contralateral occlusion?
Population
1,648 patients in good health with asymptomatic carotid atherosclerosis, including 163 with baseline…
Comparison
Prophylactic carotid endarterectomy vs Medical management
Design
Cohort
Follow-up
5 years
Authors
Discussion
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Member takes
Implication
May not benefit and possibly increase risk with contralateral occlusion; leaves open need for randomized confirmation before practice change.
Structured PICO
Does prophylactic carotid endarterectomy reduce the risk of stroke or death in patients with asymptomatic carotid atherosclerosis and contralateral occlusion?
P
Population
1,648 patients in good health with asymptomatic carotid atherosclerosis (stenosis ≥60%), including 163 with baseline contralateral occlusion and 1,485 with a patent contralateral carotid artery.
I
Intervention
Prophylactic carotid endarterectomy
C
Comparator
Medical management
O
Outcome
Combined end point of perioperative (30-day) death or stroke or long-term (5-year) ipsilateral strokecomposite
Carotid endarterectomy may provide no long-term benefit and could be harmful in asymptomatic patients with contralateral carotid occlusion due to the benign course of medically treated subjects.
Limitations
- post hoc analysis
Cite This Study
Baker et al. (2000) studied this question.