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By on-treatment (efficacy) analysis, the risk of any ipsilateral stroke at 3 years was 28.3% for medically randomized and 8.9% for surgically randomized patients (19.4% absolute risk reduction, P<0.001). For combined disabling or fatal ipsilateral stroke, the risks were 14.0% and 3.4%, respectively (10.6% absolute risk reduction). In medical patients, >80% of the first strokes at 3 years were of large-artery origin. After February 1991, 116 suitable medical patients underwent endarterectomy within 6 months, and 115 continued on medical therapy. The 3-year risk of any ipsilateral stroke in the groups of 116 and 115 patients was 7.9% and 15.0% respectively (7.1% absolute risk reduction). During follow-up, 81 patients had angiograms comparable to the baseline images. Progression by >/= 10% occurred in 7 patients; regression, in 8; no change, in 39; and occlusion, of whom 31.7% had an ipsilateral stroke before or on the day of occlusion. Endarterectomy for patients with 70% to 99% stenosis and recent symptoms was efficacious in the long term. Compared with patients who continued on medical therapy, medical patients with delayed endarterectomy experienced a moderate benefit. Medically treated patients experienced a high risk of occlusion. |
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carotid artery disease
carotid artery occlusion,neck
carotid artery stenosis
carotid artery stenosis,progression of
carotid artery stenosis,symptomatic
cerebrovascular accident
cerebrovascular accident,prevention of
efficacy
endarterectomy,carotid
endarterectomy,carotid-long term results
prognosis
treatment of neurologic disorder
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