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Carotid Endarterectomy for Asymptomatic Carotid Stenosis:A Meta-Analysis
BMJ 317:1477-1480,1468, Benavente,O.,et al, 1998
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Article Abstract
In patients who underwent carotid endarterectomy (n = 1215) there was a significant reduction in the odds of ipsilateral stroke plus perioperative stroke or death (odds ratio 0.62; 95% confidence interval 0.44 to 0.86), corresponding to a 2% absolute risk reduction over about 3.1 years. The prevalence of stroke in any location was also reduced (0.68; 0.51 to 0.9) in patients undergoing carotid endarterectomy. During the immediate postoperative period there was an increased prevalence of stroke or death amount such patients (4.51; 2.36 to 8.64). Carotid endarterectomy in patients with asymptomatic carotid stenosis unequivocally reduces the incidence of ipsilateral stroke, though the absolute benefit is relatively small. Given the modest benefit of surgery for unselected patients with asymptomatic carotid artery stenosis carotid endarterectomy cannot be routinely recommended for these patients pending reliable identification of high risk subgroups, and medical management is a sensible alternative for most patients.
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carotid artery disease
carotid artery disease,asymptomatic
carotid artery stenosis
cerebrovascular accident,prevention of
cerebrovascular disease,surgical treatment of
endarterectomy,carotid
endarterectomy,carotid-indications for
prevention of neurologic disorders
review article
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