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Carotid endarterectomy : beneficial
for SYMPTOMATIC carotid stenosis
Implication for practice:
"Patients with European Carotid Surgery Trial (ECST)-measured stenosis
>70%, North American Symptomatic Carotid Endarterectomy (NASCET)-measured
stenosis >50% ipsilateral to a recent carotid territory ischaemic event,
with a reasonable perioperative risk profile are likely to benefit from
carotid endarterectomy. The benefit is dependent on degree of stenosis
so that towards the lower end of this range, other factors, in particular
the age and sex of the patients, should be taken into account."
(Source: Cina CS,
Clase CM, Haynes RB. Carotid endarterectomy for symptomatic carotid
stenosis. In: The Cochrane Library [Online], Issue 3, 2000. Oxford:
Update Software)
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(North American Symtomatic Carotid
Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy
in symptomatic patients with high-grade carotid stenosis. N Engl J Med
1991Aug; 325(7): 445-53.
European Carotid Surgery
Trialists' Collaborative Group. MRC European Carotid Surgery Trial:
interim results for symptomatic patients with severe (70-99%) or with
mild (0-29%) carotid stenosis. Lancet 1991May; 337(8752): 1235-1243
; Randomised trial of endarterectomy for recently symptomatic carotid
stenosis: final results of the MRC European Carotid Surgery Trial [ECST].
Lancet 1998 May 9; 351(9113): 1379-87.)
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Results from meta-analysis of carotid
endarterectomy for ASYMPTOMATIC carotid stenosis patients
- As
shown from pooled data of randomised controlled trials, carotid
endarterectomy reduces the incidence of ipsilateral stroke in patients
with asymptomatic carotid stenosis, by 6.4% over an average duration
of 3.1 years, with an absolute reduction by carotid endarterectomy
of about 2% for the total follow up (see table 1).
Table 1. Effect
of carotid endarterectomy on outcomes: results of meta-analysis
| Outcome* |
Surgical
group (%) |
Medical
group (%) |
Odd
ratio** (95% CI) |
| Ipsilateral
stroke plus perioperative stroke or death |
4.4 |
6.4 |
0.62(0.44
to 0.86) |
| Ipsilateral
stroke plus perioperative ipsilateral stroke |
3.2 |
6.2 |
0.46
(0.32 to 0.66) |
| All
stroke plus perioperative stroke or death |
7.4 |
9.2 |
0.68(0.51
to 0.90) |
| Perioperative
stroke or death |
2.4 |
0.4 |
4.51(2.36
to 8.64) |
* Mean follow up
of 3 years
**Fixed effect model (Peto's method) was used to derive pooled estimates
for rates of ipsilateral stroke, all stroke, and perioperative stroke
or death. These rates were calculated by adjusting for different
sample sizes across the trials included in the meta-analysis.
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