Does carotid endarterectomy prevent disabling and fatal strokes in neurologically asymptomatic subjects?
Norman R Hertzer
Correspondence Department of Vascular Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
Email Hertzen@ccf.org
This article has no abstract so we have provided the first paragraph of the full text.
Like the Asymptomatic Carotid Atherosclerosis Study (ACAS) nearly a decade earlier,1 the Asymptomatic Carotid Surgery Trial (ACST) has been cautiously interpreted by its authors to show that CEA confers significantly greater benefit than nonoperative management for the prevention of subsequent strokes in asymptomatic patients with 60–99% stenosis of the internal carotid artery. The ACST recruited twice as many patients as the ACAS (3,120 vs 1,662) and has had longer follow-up (mean, 3.4 vs 2.7 years), but the data on which the principal conclusions of both trials are grounded appear to be quite similar on the surface. That is, the combined perioperative stroke and mortality in the surgical cohort of the ACST was 2.8% versus 2.3% in the ACAS, with an absolute stroke risk reduction (including perioperative deaths) at 5 years of 5.3% (CEA, 6.4%; no CEA, 11.7%) and 5.9% (CEA, 5.1%; no CEA, 11.0%), respectively.
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