( Choose topics from the table on the left )
What are the guidelines?
NASCET results ( North American Symptomatic carotid Endarterectomy trial)
- Prospective, randomized trial of carotid surgery in symptomatic patients:
- Group I : Best available nonoperative care
- Group II: Carotid surgery PLUS best medical care
- Results ( 18 months followup) for 70 to 99 % stenosis
|
Group
|
Number
|
Sever stroke, death
|
Risk reduction
|
All strokes
|
Risk reduction
|
|
I
|
295
|
12 %
|
|
24 %
|
|
|
II
|
300
|
5 %
|
58 %
|
7 %
|
71%
|
- Other observations from NASCET
- Contralateral carotid occlusion increases risk of stroke and death after surgery, but prognosis worse with medical treatment alone.
- Contralateral carotid severe stenosis ( 70% ) worse prognosis, but statistically significant between the two groups.
- In symptomatic ( TIA only ) patients: silent brain infarcts was observed in 1/3; prognosis worse in group I.
- Risk of stroke in Group I who presented with retinal events( temporary blindness) was higher than those who presented with hemispheric events ( loss of function/sensation in face or limbs )
- Ulcerative lesions: poorer prognosis in medically treated patients. With surgery prognosis is not worse.
- Severe stenosis: A small group of medically treated patients had repeat arteriography at 20 months which showed:
- 35 % had occluded
- 5 % had progressive stenosis
- 45 % were unchanged
- 15 % had lesser degree of stenosis
ACAS trial ( Asymptomatic Carotid Atherosclerosis Study)
- Prospective, randomized trial of 1662 asymptomatic patients
- 60 % carotid stenosis or greater
- Best medical care compared to carotid surgery
- Risk reduction from surgery is 55 %
|
Treatment
|
Stroke or death
|
|
Medical Care
|
10.6 %
|
|
Surgery
|
4.8 %
|
|
Perioperative
|
2.3 %
|
|
Arteriogram
|
1.2 %
|
|
