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Volume 328:221-227 January 28, 1993 Number 4 Next

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ABSTRACT

Background The efficacy of carotid endarterectomy in patients with asymptomatic carotid stenosis has not been confirmed in randomized clinical trials, despite the widespread use of operative intervention in such patients.

Methods We conducted a multicenter clinical trial at 11 Veterans Affairs medical centers to determine the effect of carotid endarterectomy on the combined incidence of transient ischemic attack, transient monocular blindness, and stroke. We studied 444 men with asymptomatic carotid stenosis shown arteriographically to reduce the diameter of the arterial lumen by 50 percent or more. The patients were randomly assigned to optimal medical treatment including antiplatelet medication (aspirin) plus carotid endarterectomy (the surgical group; 211 patients) or optimal medical treatment alone (the medical group; 233 patients). All the patients at each center were followed independently by a vascular surgeon and a neurologist for a mean of 47.9 months.

Results The combined incidence of ipsilateral neurologic events was 8.0 percent in the surgical group and 20.6 percent in the medical group (P<0.001), giving a relative risk (for the surgical group vs. the medical group) of 0.38 (95 percent confidence interval, 0.22 to 0.67). The incidence of ipsilateral stroke alone was 4.7 percent in the surgical group and 9.4 percent in the medical group. An analysis of stroke and death combined within the first 30 postoperative days showed no significant differences. Nor were there significant differences between groups in an analysis of all strokes and deaths (surgical, 41.2 percent; medical, 44.2 percent; relative risk, 0.92; 95 percent confidence interval, 0.69 to 1.22). Overall mortality, including postoperative deaths, was primarily due to coronary atherosclerosis.

Conclusions Carotid endarterectomy reduced the overall incidence of ipsilateral neurologic events in a selected group of male patients with asymptomatic carotid stenosis. We did not find a significant influence of carotid endarterectomy on the combined incidence of stroke and death, but because of the size of our sample, a modest effect could not be excluded.

Source Information

From the Veterans Affairs Cooperative Studies Program Coordinating Center, Perry Point, Md., and 11 Veterans Affairs medical centers. Participants and participating centers are listed in the Appendix.

Address reprint requests to Dr. Hobson at the Section of Vascular Surgery, Medical Science Building G-532, 185 S. Orange Ave., University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, NJ 07103.

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• Chaturvedi, S., Bruno, A., Feasby, T., Holloway, R., Benavente, O., Cohen, S. N., Cote, R., Hess, D., Saver, J., Spence, J. D., Stern, B., Wilterdink, J. (2005). Carotid endarterectomy--An evidence-based review: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 65: 794-801 [Abstract] [Full Text]  
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• Mohammed, N., Anand, S. S (2005). Vascular viewpoint. Vasc Med 10: 77-78 [Abstract]  
• Hyde, D. E., Fox, A. J., Gulka, I., Kalapos, P., Lee, D. H., Pelz, D. M., Holdsworth, D. W. (2004). Internal Carotid Artery Stenosis Measurement: Comparison of 3D Computed Rotational Angiography and Conventional Digital Subtraction Angiography. Stroke 35: 2776-2781 [Abstract] [Full Text]  
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• Rothwell, P.M., Goldstein, L.B. (2004). Carotid Endarterectomy for Asymptomatic Carotid Stenosis: Asymptomatic Carotid Surgery Trial. Stroke 35: 2425-2427 [Full Text]  
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• Dodick, D. W., Meissner, I., Meyer, F. B., Cloft, H. J. (2004). Evaluation and Management of Asymptomatic Carotid Artery Stenosis. Mayo Clin Proc. 79: 937-944 [Abstract]  
• Cestari, D. M., Weine, D. M., Panageas, K. S., Segal, A. Z., DeAngelis, L. M. (2004). Stroke in patients with cancer: Incidence and etiology. Neurology 62: 2025-2030 [Abstract] [Full Text]  
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• Higashida, R. T., Meyers, P. M., Phatouros, C. C., Connors, J. J. III, Barr, J. D., Sacks, D., for the Technology Assessment Committees of the Am, (2004). Reporting Standards for Carotid Artery Angioplasty and Stent Placement. Stroke 35: e112-e134 [Full Text]  
• Sacco, R. L. (2004). Risk factors for TIA and TIA as a risk factor for stroke. Neurology 62: S7-S11 [Full Text]  
• Cheanvechai, V., Harthun, N. L., Graham, L. M., Freischlag, J. A., Gahtan, V. (2004). Incidence of peripheral vascular disease in women: Is it different from that in men?. J. Thorac. Cardiovasc. Surg. 127: 314-317 [Full Text]  
• Barr, J. D., Connors, J. J. III, Sacks, D., Wojak, J. C., Becker, G. J., Cardella, J. F., Chopko, B., Dion, J. E., Fox, A. J., Higashida, R. T., Hurst, R. W., Lewis, C. A., Matalon, T. A.S., Nesbit, G. M., Pollock, J. A., Russell, E. J., Seidenwurm, D. J., Wallace, R. C. (2003). Quality Improvement Guidelines for the Performance of Cervical Carotid Angioplasty and Stent Placement: Developed by a Collaborative Panel of the American Society of Interventional and Therapeutic Neuroradiology, the American Society of Neuroradiology, and the Society of Interventional Radiology. Am. J. Neuroradiol. 24: 2020-2034 [Full Text]  
• Goldstein, L. B. (2003). Extracranial Carotid Artery Stenosis. Stroke 34: 2767-2773 [Abstract] [Full Text]  
• Bertges, D. J., Muluk, V., Whittle, J., Kelley, M., MacPherson, D. S., Muluk, S. C. (2003). Relevance of Carotid Stenosis Progression as a Predictor of Ischemic Neurological Outcomes. Arch Intern Med 163: 2285-2289 [Abstract] [Full Text]  
• Moore, W. S. (2003). Resolved: NASCET and ACAS Need Not Be Repeated: The Affirmative Position. Arch Neurol 60: 775-778 [Full Text]  
• Ballotta, E. (2003). Editorial Comment--Female Sex: A Questionable Risk Factor for Carotid Endarterectomy. Stroke 34: 1124-1125 [Full Text]  
• Kawahito, S., Kitahata, H., Tanaka, K., Nozaki, J., Oshita, S. (2003). Dynamic QRS-complex and ST-segment monitoring by continuous vectorcardiography during carotid endarterectomy. Br J Anaesth 90: 142-147 [Abstract] [Full Text]  
• Claiborne Johnston, S., Sidney, S., Bernstein, A. L., Gress, D. R. (2003). A comparison of risk factors for recurrent TIA and stroke in patients diagnosed with TIA. Neurology 60: 280-285 [Abstract] [Full Text]  
• Akins, C. W., Moncure, A. C. (2003). Myocardial Revascularization with Carotid Artery Disease. Card Surg Adult 2: 627-637 [Full Text]  
• (2002). References. Circulation 106: 3373-3421 [Full Text]  
• Barnett, H. J. M. (2002). Efficacy of Carotid Endarterectomy Translates to Being Efficacious With Appropriate Surgical Skill. Arch Neurol 59: 1866-1868 [Full Text]  
• Anderson, D.C., Kappelle, L.J., Eliasziw, M., Babikian, V.L., Pearce, L.A., Barnett, H.J.M., Blakely, J. (2002). Occurrence of Hemispheric and Retinal Ischemia in Atrial Fibrillation Compared With Carotid Stenosis * Editorial Comment. Stroke 33: 1963-1968 [Abstract] [Full Text]  
• Abou-Zamzam, A. M. Jr, Moneta, G. L., Landry, G. J., Yeager, R. A., Edwards, J. M., McConnell, D. B., Taylor, L. M. Jr, Porter, J. M. (2002). Carotid Surgery Following Previous Carotid Endarterectomy Is Safe and Effective. VASC ENDOVASCULAR SURG 36: 263-270 [Abstract]  
• Marien, B. J., Raffetto, J. D., Seidman, C. S., LaMorte, W. W., Menzoian, J. O. (2002). Bovine Pericardium vs Dacron for Patch Angioplasty After Carotid Endarterectomy: A Prospective Randomized Study. Arch Surg 137: 785-788 [Abstract] [Full Text]  
• Cook, R J, Lawless, J F (2002). Analysis of repeated events. Stat Methods Med Res 11: 141-166 [Abstract]  
• Barnett, H. J.M., Meldrum, H. E., Eliasziw, M. (2002). The appropriate use of carotid endarterectomy. CMAJ 166: 1169-1179 [Abstract] [Full Text]  
• Post, P. N., Kievit, J., van Baalen, J. M., van den Hout, W. B., van Bockel, J. H. (2002). Routine Duplex Surveillance Does Not Improve the Outcome After Carotid Endarterectomy: A Decision and Cost Utility Analysis. Stroke 33: 749-755 [Abstract] [Full Text]  
• Remonda, L., Senn, P., Barth, A., Arnold, M., Lovblad, K.-O., Schroth, G. (2002). Contrast-Enhanced 3D MR Angiography of the Carotid Artery: Comparison with Conventional Digital Subtraction Angiography. Am. J. Neuroradiol. 23: 213-219 [Abstract] [Full Text]  
• Heyer, E. J., Sharma, R., Rampersad, A., Winfree, C. J., Mack, W. J., Solomon, R. A., Todd, G. J., McCormick, P. C., McMurtry, J. G., Quest, D. O., Stern, Y., Lazar, R. M., Connolly, E. S. (2002). A Controlled Prospective Study of Neuropsychological Dysfunction Following Carotid Endarterectomy. Arch Neurol 59: 217-222 [Abstract] [Full Text]  
• Hannan, E. L., Popp, A. J., Feustel, P., Halm, E., Bernardini, G., Waldman, J., Shah, D., Chassin, M. R. (2001). Association of Surgical Specialty and Processes of Care With Patient Outcomes for Carotid Endarterectomy. Stroke 32: 2890-2897 [Abstract] [Full Text]  
• Brooks, W. H., McClure, R. R., Jones, M. R., Coleman, T. C., Breathitt, L. (2001). Carotid angioplasty and stenting versus carotid endarterectomy: randomized trial in a community hospital. J Am Coll Cardiol 38: 1589-1595 [Abstract] [Full Text]  
• Ayerdi, J., Sampson, L. N., Deshmukh, N., Farid, A., Gupta, S. K. (2001). Carotid Endarterectomy in Patients with Renal Insufficiency: Should Selection Criteria be Different in Patients with Renal Insufficiency?. VASC ENDOVASCULAR SURG 35: 429-435 [Abstract]  
• Sacco, R. L. (2001). Extracranial Carotid Stenosis. NEJM 345: 1113-1118 [Full Text]  
• Dietz, A., Berkefeld, J., Theron, J. G., Schmitz-Rixen, T., Zanella, F. E., Turowski, B., Steinmetz, H., Sitzer, M. (2001). Endovascular Treatment of Symptomatic Carotid Stenosis Using Stent Placement: Long-Term Follow-Up of Patients With a Balanced Surgical Risk/Benefit Ratio. Stroke 32: 1855-1859 [Abstract] [Full Text]  
• Dinkel, H-P, Moll, R, Debus, S (2001). Colour flow Doppler ultrasound of the carotid bifurcation: can it replace routine angiography before carotid endarterectomy?. Br. J. Radiol. 74: 590-594 [Abstract] [Full Text]  
• Mukherjee, D., Yadav, J. S., Howard, V. J., Howard, G., Baker, W. H. (2001). Effect of Contralateral Occlusion on Long-Term Efficacy of Endarterectomy in the Asymptomatic Carotid Atherosclerosis Study (ACAS) Response. Stroke 32 : 1443-1448 [Full Text]  
• Gaudino, M., Glieca, F., Luciani, N., Cellini, C., Morelli, M., Spatuzza, P., Di Mauro, M., Alessandrini, F., Possati, G. (2001). Should severe monolateral asymptomatic carotid artery stenosis be treated at the time of coronary artery bypass operation?. Eur. J. Cardiothorac. Surg. 19: 619-626 [Abstract] [Full Text]  
• Melissano, G., Castellano, R., Zucca, R., Chiesa, R. (2001). Results of Carotid Endarterectomy Performed with Preoperative Duplex Ultrasound Assessment Alone. VASC ENDOVASCULAR SURG 35: 95-101 [Abstract]  
• Roubin, G. S., New, G., Iyer, S. S., Vitek, J. J., Al-Mubarak, N., Liu, M. W., Yadav, J., Gomez, C., Kuntz, R. E. (2001). Immediate and Late Clinical Outcomes of Carotid Artery Stenting in Patients With Symptomatic and Asymptomatic Carotid Artery Stenosis : A 5-Year Prospective Analysis. Circulation 103: 532-537 [Abstract] [Full Text]  
• Goldstein, L. B., Adams, R., Becker, K., Furberg, C. D., Gorelick, P. B., Hademenos, G., Hill, M., Howard, G., Howard, V. J., Jacobs, B., Levine, S. R., Mosca, L., Sacco, R. L., Sherman, D. G., Wolf, P. A., del Zoppo, G. J., Members, (2001). Primary Prevention of Ischemic Stroke : A Statement for Healthcare Professionals From the Stroke Council of the American Heart Association. Circulation 103: 163-182 [Full Text]  
• Goldstein, L. B., Adams, R., Becker, K., Furberg, C. D., Gorelick, P. B., Hademenos, G., Hill, M., Howard, G., Howard, V. J., Jacobs, B., Levine, S. R., Mosca, L., Sacco, R. L., Sherman, D. G., Wolf, P. A., del Zoppo, G. J. (2001). Primary Prevention of Ischemic Stroke : A Statement for Healthcare Professionals From the Stroke Council of the American Heart Association. Stroke 32: 280-299 [Full Text]  
• Gross, C. P., Steiner, C. A., Bass, E. B., Powe, N. R. (2000). Relation Between Prepublication Release of Clinical Trial Results and the Practice of Carotid Endarterectomy. JAMA 284: 2886-2893 [Abstract] [Full Text]  
• Tegos, T. J., Kalodiki, E., Nicolaides, A. N. (2000). Stroke: Management and Rehabilitation: Part III of III. ANGIOLOGY 51: 977-984 [Abstract]  
• Phatouros, C. C., Higashida, R. T., Malek, A. M., Meyers, P. M., Lempert, T. E., Dowd, C. F., Halbach, V. V. (2000). Carotid Artery Stent Placement for Atherosclerotic Disease: Rationale, Technique, and Current Status. Radiology 217: 26-41 [Abstract] [Full Text]  
• O'Neill, L., Lanska, D. J., Hartz, A. (2000). Surgeon characteristics associated with mortality and morbidity following carotid endarterectomy. Neurology 55: 773-781 [Abstract] [Full Text]  
• Benesch, C. G., Chimowitz, M. I. (2000). Best treatment for intracranial arterial stenosis?: 50 years of uncertainty. Neurology 55: 465-466 [Full Text]  
• Olcott IV, C., Mitchell, R. S., Steinberg, G. K., Zarins, C. K. (2000). Institutional Peer Review Can Reduce the Risk and Cost of Carotid Endarterectomy. Arch Surg 135: 939-942 [Abstract] [Full Text]  
• Schminke, U., Motsch, L., Hilker, L., Kessler, C. (2000). Three-Dimensional Ultrasound Observation of Carotid Artery Plaque Ulceration. Stroke 31: 1651-1655 [Abstract] [Full Text]  
• Silvestrini, M., Vernieri, F., Pasqualetti, P., Matteis, M., Passarelli, F., Troisi, E., Caltagirone, C. (2000). Impaired Cerebral Vasoreactivity and Risk of Stroke in Patients With Asymptomatic Carotid Artery Stenosis. JAMA 283: 2122-2127 [Abstract] [Full Text]  
• Connors III, J. J., Seidenwurm, D., Wojak, J. C., Hurst, R. W., Jensen, M. E., Wallace, R., Tomsick, T., Barr, J., Kerber, C., Russell, E., Nesbit, G. M., Fox, A. J., Tsai, F. Y. (2000). Treatment of Atherosclerotic Disease at the Cervical Carotid Bifurcation: Current Status and Review of the Literature. Am. J. Neuroradiol. 21: 444-450 [Full Text]  
• Golledge, J., Greenhalgh, R. M., Davies, A. H. (2000). The Symptomatic Carotid Plaque. Stroke 31: 774-781 [Abstract] [Full Text]  
• Koskas, F., Kieffer, E. (2000). Carotid Eversion Endarterectomy: Should We Abandon the Standard Technique?. PERSPECT VASC SURG ENDOVASC THER 13: 115-126 [Abstract]  
• Barnett, H. J. M., Meldrum, H. E. (2000). Carotid Endarterectomy: A Neurotherapeutic Advance. Arch Neurol 57: 40-45 [Full Text]  
• Gorelick, P. B. (1999). Carotid Endarterectomy : Where Do We Draw the Line?. Stroke 30: 1745-1750 [Full Text]  
• Chaturvedi, S. (1999). Is Carotid Endarterectomy Appropriate for Asymptomatic Stenosis?: No. Arch Neurol 56: 879-881 [Full Text]  
• Barnett, H. J M, Eliasziw, M., Meldrum, H. E (1999). Evidence based cardiology: Prevention of ischaemic stroke. BMJ 318: 1539-1543 [Full Text]  
• Treiman, G. S. (1999). The Natural History of Asymptomatic Carotid Stenosis: Assessing the Risk and Rate of Disease Progression. PERSPECT VASC SURG ENDOVASC THER 11: 95-109 [Abstract]  
• Muluk, S. (1999). Natural History of Asymptomatic Carotid Stenosis: When Should We Operate and Why?. PERSPECT VASC SURG ENDOVASC THER 12: 15-26 [Abstract]  
• Wong, J. H., Lubkey, T. B., Suarez-Almazor, M. E., Findlay, J. M. (1999). Improving the Appropriateness of Carotid Endarterectomy : Results of a Prospective City-Wide Study. Stroke 30: 12-15 [Abstract] [Full Text]  
• Benavente, O., Moher, D., Pham, B. (1998). Carotid endarterectomy for asymptomatic carotid stenosis: a meta-analysis. BMJ 317: 1477-1480 [Abstract] [Full Text]  
• Robertson, J. T. (1998). Carotid Endarterectomy: A Saga of Clinical Science, Personalities, and Evolving Technology : The Willis Lecture. Stroke 29: 2435-2441 [Full Text]  
• Chaturvedi, S., Huber, T. S., Wheeler, K. G., Cuddeback, J. K., Dame, D. A., Flynn, T. C., Seeger, J. M. (1998). Is the Increasing Volume of Carotid Endarterectomy Justified? • Response. Stroke 29: 2444-2446 [Full Text]  
• Akins, C. W. (1998). Combined carotid endarterectomy and coronary revascularization operation. Ann. Thorac. Surg. 66: 1483-1484 [Full Text]  
• Moore, W. S., Kempczinski, R. F., Nelson, J. J., Toole, J. F. (1998). Recurrent Carotid Stenosis : Results of the Asymptomatic Carotid Atherosclerosis Study. Stroke 29: 2018-2025 [Abstract] [Full Text]