Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis

North American Symptomatic Carotid Endarterectomy Trial Collaborators

Research output: Contribution to journalArticle

6935 Citations (Scopus)

Abstract

Background. Without strong evidence of benefit, the use of carotid endarterectomy for prophylaxis against stroke rose dramatically until the mid-1980s, then declined. Our investigation sought to determine whether carotid endarterectomy reduces the risk of stroke among patients with a recent adverse cerebrovascular event and ipsilateral carotid stenosis. Method. We conducted a randomized trial at 50 clinical centers throughout the United States and Canada, in patients in two predetermined strata based on the severity of carotid stenosis—30 to 69 percent and 70 to 99 percent. We report here the results in the 659 patients in the latter stratum, who had had a hemispheric or retinal transient ischemic attack or a nondisabling stroke within the 120 days before entry and had stenosis of 70 to 99 percent in the symptomatic carotid artery. All patients received optimal medical care, including antiplatelet therapy. Those assigned to surgical treatment underwent carotid endarterectomy performed by neurosurgeons or vascular surgeons. All patients were examined by neurologists 1, 3, 6, 9, and 12 months after entry and then every 4 months. End points were assessed by blinded, independent case review. No patient was lost to follow-up. Results. Life-table estimates of the cumulative risk of any ipsilateral stroke at two years were 26 percent in the 331 medical patients and 9 percent in the 328 surgical patients—an absolute risk reduction (±SE) of 17±3.5 percent (P<0.001). For a major or fatal ipsilateral stroke, the corresponding estimates were 13.1 percent and 2.5 percent — an absolute risk reduction of 10.6±2.6 percent (P<0.001 ). Conclusion. Carotid endarterectomy was still found to be beneficial when all strokes and deaths were included in the analysis (P<0.001). Carotid endarterectomy is highly beneficial to patients with recent hemispheric and retinal transient ischemic attacks or nondisabling strokes and ipsilateral high-grade stenosis (70 to 99 percent) of the internal carotid artery. (N Engl J Med 1991; 325:445–53.).

Original languageEnglish (US)
Pages (from-to)445-453
Number of pages9
JournalNew England Journal of Medicine
Volume325
Issue number7
DOIs
StatePublished - Aug 15 1991
Externally publishedYes

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Carotid Endarterectomy
Carotid Stenosis
Stroke
Numbers Needed To Treat
Transient Ischemic Attack
Pathologic Constriction
Life Tables
Lost to Follow-Up
Internal Carotid Artery
Carotid Arteries
Canada
Blood Vessels
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. / North American Symptomatic Carotid Endarterectomy Trial Collaborators.

In: New England Journal of Medicine, Vol. 325, No. 7, 15.08.1991, p. 445-453.

Research output: Contribution to journalArticle

North American Symptomatic Carotid Endarterectomy Trial Collaborators. / Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. In: New England Journal of Medicine. 1991 ; Vol. 325, No. 7. pp. 445-453.
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abstract = "Background. Without strong evidence of benefit, the use of carotid endarterectomy for prophylaxis against stroke rose dramatically until the mid-1980s, then declined. Our investigation sought to determine whether carotid endarterectomy reduces the risk of stroke among patients with a recent adverse cerebrovascular event and ipsilateral carotid stenosis. Method. We conducted a randomized trial at 50 clinical centers throughout the United States and Canada, in patients in two predetermined strata based on the severity of carotid stenosis—30 to 69 percent and 70 to 99 percent. We report here the results in the 659 patients in the latter stratum, who had had a hemispheric or retinal transient ischemic attack or a nondisabling stroke within the 120 days before entry and had stenosis of 70 to 99 percent in the symptomatic carotid artery. All patients received optimal medical care, including antiplatelet therapy. Those assigned to surgical treatment underwent carotid endarterectomy performed by neurosurgeons or vascular surgeons. All patients were examined by neurologists 1, 3, 6, 9, and 12 months after entry and then every 4 months. End points were assessed by blinded, independent case review. No patient was lost to follow-up. Results. Life-table estimates of the cumulative risk of any ipsilateral stroke at two years were 26 percent in the 331 medical patients and 9 percent in the 328 surgical patients—an absolute risk reduction (±SE) of 17±3.5 percent (P<0.001). For a major or fatal ipsilateral stroke, the corresponding estimates were 13.1 percent and 2.5 percent — an absolute risk reduction of 10.6±2.6 percent (P<0.001 ). Conclusion. Carotid endarterectomy was still found to be beneficial when all strokes and deaths were included in the analysis (P<0.001). Carotid endarterectomy is highly beneficial to patients with recent hemispheric and retinal transient ischemic attacks or nondisabling strokes and ipsilateral high-grade stenosis (70 to 99 percent) of the internal carotid artery. (N Engl J Med 1991; 325:445–53.).",
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TY - JOUR

T1 - Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis

AU - North American Symptomatic Carotid Endarterectomy Trial Collaborators

AU - Taylor, D. W.

AU - Haynes, R. B.

AU - Sackett, D. L.

AU - Peerless, S. J.

AU - Ferguson, G. G.

AU - Fox, A. J.

AU - Rankin, R. N.

AU - Hachinski, V. C.

AU - Wiebers, D. O.

AU - Eliasziw, M.

AU - Barr, H. W.K.

AU - Clagett, G. P.

AU - Easton, J. D.

AU - Harbison, J. W.

AU - Heros, R. C.

AU - Hudson, A. R.

AU - Marler, J. R.

AU - Ratcheson, R. A.

AU - Sim, D.

AU - Simard, D.

AU - Walker, M. D.

AU - Walker, P. M.

AU - Wolf, P. A.

AU - Peerless, S. J.

AU - Ferguson, G. G.

AU - Clagett, G. P.

AU - Heros, R. C.

AU - Hudson, A. R.

AU - Patterson, R. H.

AU - Webster, M.

AU - Ratcheson, R. A.

AU - Walker, P. M.

AU - Hachinski, V. C.

AU - Swan, C.

AU - White, C.

AU - Ferguson, G. G.

AU - Peerless, S. J.

AU - Reichman, H.

AU - Silver, F. L.

AU - Huth, B.

AU - Slattery, S.

AU - Bayer, N. H.

AU - Borrett, D. S.

AU - Campbell, V. M.

AU - Fleming, J. F.R.

AU - Gentili, F.

AU - Keller, M. A.

AU - Moulton, R. J.

AU - Muller, P. J.

AU - Flamm, Eugene S.

PY - 1991/8/15

Y1 - 1991/8/15

N2 - Background. Without strong evidence of benefit, the use of carotid endarterectomy for prophylaxis against stroke rose dramatically until the mid-1980s, then declined. Our investigation sought to determine whether carotid endarterectomy reduces the risk of stroke among patients with a recent adverse cerebrovascular event and ipsilateral carotid stenosis. Method. We conducted a randomized trial at 50 clinical centers throughout the United States and Canada, in patients in two predetermined strata based on the severity of carotid stenosis—30 to 69 percent and 70 to 99 percent. We report here the results in the 659 patients in the latter stratum, who had had a hemispheric or retinal transient ischemic attack or a nondisabling stroke within the 120 days before entry and had stenosis of 70 to 99 percent in the symptomatic carotid artery. All patients received optimal medical care, including antiplatelet therapy. Those assigned to surgical treatment underwent carotid endarterectomy performed by neurosurgeons or vascular surgeons. All patients were examined by neurologists 1, 3, 6, 9, and 12 months after entry and then every 4 months. End points were assessed by blinded, independent case review. No patient was lost to follow-up. Results. Life-table estimates of the cumulative risk of any ipsilateral stroke at two years were 26 percent in the 331 medical patients and 9 percent in the 328 surgical patients—an absolute risk reduction (±SE) of 17±3.5 percent (P<0.001). For a major or fatal ipsilateral stroke, the corresponding estimates were 13.1 percent and 2.5 percent — an absolute risk reduction of 10.6±2.6 percent (P<0.001 ). Conclusion. Carotid endarterectomy was still found to be beneficial when all strokes and deaths were included in the analysis (P<0.001). Carotid endarterectomy is highly beneficial to patients with recent hemispheric and retinal transient ischemic attacks or nondisabling strokes and ipsilateral high-grade stenosis (70 to 99 percent) of the internal carotid artery. (N Engl J Med 1991; 325:445–53.).

AB - Background. Without strong evidence of benefit, the use of carotid endarterectomy for prophylaxis against stroke rose dramatically until the mid-1980s, then declined. Our investigation sought to determine whether carotid endarterectomy reduces the risk of stroke among patients with a recent adverse cerebrovascular event and ipsilateral carotid stenosis. Method. We conducted a randomized trial at 50 clinical centers throughout the United States and Canada, in patients in two predetermined strata based on the severity of carotid stenosis—30 to 69 percent and 70 to 99 percent. We report here the results in the 659 patients in the latter stratum, who had had a hemispheric or retinal transient ischemic attack or a nondisabling stroke within the 120 days before entry and had stenosis of 70 to 99 percent in the symptomatic carotid artery. All patients received optimal medical care, including antiplatelet therapy. Those assigned to surgical treatment underwent carotid endarterectomy performed by neurosurgeons or vascular surgeons. All patients were examined by neurologists 1, 3, 6, 9, and 12 months after entry and then every 4 months. End points were assessed by blinded, independent case review. No patient was lost to follow-up. Results. Life-table estimates of the cumulative risk of any ipsilateral stroke at two years were 26 percent in the 331 medical patients and 9 percent in the 328 surgical patients—an absolute risk reduction (±SE) of 17±3.5 percent (P<0.001). For a major or fatal ipsilateral stroke, the corresponding estimates were 13.1 percent and 2.5 percent — an absolute risk reduction of 10.6±2.6 percent (P<0.001 ). Conclusion. Carotid endarterectomy was still found to be beneficial when all strokes and deaths were included in the analysis (P<0.001). Carotid endarterectomy is highly beneficial to patients with recent hemispheric and retinal transient ischemic attacks or nondisabling strokes and ipsilateral high-grade stenosis (70 to 99 percent) of the internal carotid artery. (N Engl J Med 1991; 325:445–53.).

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