RT Journal Article
SR Electronic
T1 The risks and benefits of carotid endarterectomy in patients with near occlusion of the carotid artery
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP 911
OP 915
DO 10.1212/WNL.48.4.911
VO 48
IS 4
A1 L. B. Morgenstern
A1 A. J. Fox
A1 B. L. Sharpe
A1 M. Eliasziw
A1 H.J.M. Barnett
A1 J. C. Grotta
YR 1997
UL http://n.neurology.org/content/48/4/911.abstract
AB Some believe that carotid endarterectomy (CEA) for carotid near occlusion is a necessary emergency procedure while others call it dangerous. We used the North American Symptomatic Carotid Endarterectomy Trial (NASCET) data to perform an observational study to examine the safety and benefit of CEA for carotid near occlusion. We divided the data of 659 patients into stenosis groups: 70 to 79%, 80 to 89%, 90 to 94%, and near occlusion. The 106 carotid-near-occlusion patients were subdivided into those with a string-like lumen (n = 29) and those without a string-like lumen (n = 77). Of the 48 patients with near occlusion treated with CEA, 3 (6.3%) had perioperative strokes, similar to the 70–94% stenosis group. Only 1 of 58 patients (1.7%) with near occlusion treated medically had a stroke in the first month, suggesting that CEA is not needed on an emergency basis in this circumstance. For medically treated patients, the 1-year risk of stroke increases with escalating degrees of carotid stenosis, where the risk is 35.1% for patients with 90–94% stenosis. For patients with near occlusion, the 1-year stroke risk diminishes to 11.1%, which approximates the risk for patients with 70–89% stenosis. A comparison of treatment differences indicates that surgery reduces the risk of stroke at 1 year by approximately one-half (p < 0.001), regardless of the degree of stenosis or the subcategory of carotid near occlusion (p = 0.89). Our data suggest that CEA is beneficial for near occlusion and not more dangerous than in patients with 70–94% stenosis, provided that the procedure is performed by an experienced surgeon with a low complication rate.