Key result
CEA cuts 5-year stroke risk by an absolute ~5% in asymptomatic carotid stenosis.
Why the study?
There is uncertainty about the optimal stroke prevention strategy in patients with asymptomatic carotid artery stenosis, including the role of CEA combined with best medical treatment versus medical management or surgery alone.
Does carotid endarterectomy combined with best medical treatment prevent stroke in patients with asymptomatic carotid artery stenosis?
Population
Patients with asymptomatic carotid artery stenosis, aged 40-75 years, with 60-99% stenosis and life expectancy of at least 5 years
Comparison
CEA combined with best medical treatment versus medical management alone or surgery alone
Design
Review
Authors
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Low long-term risk reduction with CEA in asymptomatic stenosis warrants caution in selection; leaves open whether contemporary medical therapy narrows benefit.
Does carotid endarterectomy combined with best medical treatment prevent stroke in patients with asymptomatic carotid artery stenosis?
Absolute Risk Reduction: 5.4
Absolute Risk Reduction: 5.4%
Number Needed to Treat: 21
Carotid endarterectomy combined with best medical treatment is recommended for stroke prevention in selected high-risk patients with asymptomatic carotid stenosis, provided surgical risk is low.
Cardona et al. (2007) conducted a review in Asymptomatic carotid artery stenosis. Carotid endarterectomy vs. Medical management was evaluated on Stroke (ARR 5.4%). Carotid endarterectomy for asymptomatic carotid artery stenosis provides an absolute risk reduction of 5.4% for stroke prevention over 5 years (NNT: 21).