Carotid stenosis: endarterectomy for asymptomatic carotid stenosis
DISEASE INTERVENTION COMPARISON RESULTS
BMJ. 1998 Nov 28;317(7171):1477-1480 Meta-Analysis
IN stroke, ischemic, carotid stenosis, asymptomatic The Use of
carotid endarterectomy
As Prevention, Primary
Is better Than
deferral of endarterectomy to symptoms
To reduce stroke at long term: a 2% absolute risk reduction over about 3.1 years. Stroke and death in the 30-day perioperative period were increased.
Lancet. 2004 May 8;363(9420):1491-502 Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, carotid stenosis, asymptomatic The Use of
carotid endarterectomy
As Prevention, Primary
Is better Than
indefinite deferral of endarterectomy to symptoms
To reduce stroke at 5 years: 6.4% intv. VS 11.8% ctrl. for all strokes, 3.5% intv. VS 6.1% ctrl. for fatal or disabling strokes. Risk of stroke or death within 30 days of endarterectomy was 3.1%.
Cochrane Database Syst Rev. 2005 Oct 19;(4):CD001923 Systematic Review, Cochrane Review
IN stroke, ischemic, carotid stenosis, asymptomatic The Use of
carotid endarterectomy
As Treatment, Acute
Is better Than
medical treatment alone
To reduce strokes at 3 years (combined outcome of perioperative death or any stroke, operative or later): RR 0.69, ARR 1% per year, having a 3% of perioperative death or stroke.
N Engl J Med. 2004 Oct 7;351(15):1493-501 Randomized Controlled Trial
IN stroke, ischemic, carotid stenosis, asymptomatic (80%) or symptomatic (50%) The Use of
carotid-artery stenting with an emboli-protection device
As Treatment, Acute
Is better Than
endarterectomy
To reduce major cardiovascular events at 1 year (death, stroke or perioperatory infarction): 12.2% stent VS 20.1% endarcterectomy, p NS