Carotid endarterectomy: current status, and effects of clinical trials.
With the interim results of the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the European Carotid Surgery Trial (ECST) now reported, it has been shown that carotid endarterectomy is superior to conventional medical therapy for the treatment of symptomatic patients with > 70% diameter-reducing stenosis. The Veterans' Administration trial in asymptomatic patients with a > 50% diameter-reducing stenosis has shown that endarterectomy is superior to conventional non-operative treatment for the prevention of transient ischemic attacks and strokes when these events are combined. The design, impact and potential shortcomings of these trials are reviewed.
Strandness
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Division of Vascular Surgery, University of Washington School of Medicine, Seattle 98195.
D002343:Carotid Artery, Internal / Q000601:surgery; D016893:Carotid Stenosis / Q000401:mortality / Q000601:surgery*; D002561:Cerebrovascular Disorders / Q000401:mortality / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000379:methods* / Q000401:mortality; D006801:Humans; D002546:Ischemic Attack, Transient / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome