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Among patients with stenosis of 50 to 69%, the five-year rate of any ipsilateral stroke (failure rate) was 15.7% among patients treated surgically and 22.2% among those treated medically (P=0.045); to prevent one ipsilateral stroke during the five-year period, 15 patients would have to be treated with carotid endarterectomy. Among patients with less than 50% stenosis, the failure rate was not significantly lower in the group treated with endarterectomy (14.9%) than in the medically treated group (18.7%, P=0.16). Among the patients with severe stenosis who underwent endarterectomy, the 30-day rate of death or disabling ipsilateral stroke persisting at 90 days was 2.1%; this rate increased to only 6.7% at 8 eights. Benefit was greatest among men, patients with recent stroke as the qualifying event, and patients with hemispheric symptoms. Endarterectomy in patients with symptomatic moderate carotid stenosis of 50 to 69% yielded only a moderate reductions in the risk of stroke. Decisions about treatment for patients in this category must take into account recognized risk factors, and exceptional surgical skill is obligatory if carotid endarterectomy is to be performed. Patients with stenosis of less than 50% did not benefit from surgery. Patients with severe stenosis (>/= 70%) had a durable benefit for endarterectomy at eight years of follow-up. |
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cerebrovascular accident,prevention of
endarterectomy,carotid
endarterectomy,carotid-indications for
prevention of neurologic disorders
review article
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