Carotid Endarterectomy:Recommendations for Manag of Transient Ischaemic Attack and Ischaemic Stroke

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Carotid Endarterectomy:Recommendations for Manag of Transient Ischaemic Attack and Ischaemic Stroke
BMJ 305:1071-1074, Brown,M.M.,et al, 1992 See this aricle in Pubmed

Article Abstract
Although carotid surgery was first performed in the early 1950s,the benefit of surgery has only recently been convincingly established by two large international multicentre randomised trials.The collaborators in the European carotid surgery trial and the North American symptomatic carotid endarterectomy trial have published data showing the value of carotid endarterectomy in patients with severe stenosis(70-99%linear reduction in diameter)who have had recent cerebrovascular symptoms in the carotid artery territory.In both studies the risk of ischaemic stroke over two or three years after surgery was reduced by 75%(table I).The risk of perioperative severe stroke or death was 3.7%in the European trial and 2. 1%in the North American trial.Allowing for the initial surgical risk,the patient allocated to surgery started to do better than patients in the non-surgical group after about 10 months in the European trial or six months in the North American trial.The European trial also showed that endarterectomy had no significant benefit in patients with mild carotid stenosis(less than 30%),mainly because of a low event rate in this group. The North American trial did not include patients with mild stenosis.The value of carotid endarterectomy in symptomatic patients with moderate stenosis of 30-69%is still uncertain and both studies are continuing to randomise patients with this degree of stenosis.There is no evidence that asymptomatic patients with severe stenosis should be operated on,although other trials are examining this problem.

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