title: An analysis of perioperative surgical mortality and morbidity in the asymptomatic carotid atherosclerosis study. ACAS Investigators. Asymptomatic Carotid Atherosclerosis Study.
abstract: OBJECTIVE
  Our aim was to determine the perioperative morbidity and mortality rates of patients in the surgical arm of the multi-institutional, prospective, randomized Asymptomatic Carotid Atherosclerosis Study (ACAS).
  
  
  METHODS
  Of 828 patients with carotid stenosis of 60% or more randomized to the surgical arm of ACAS, 721 underwent carotid endarterectomy (CEA). To qualify for participation, surgeons were required to have performed at least 12 CEAs per year with a combined neurological morbidity and mortality rate no greater than 3% for asymptomatic patients and 5% for symptomatic patients. Clinical centers had to demonstrate arteriographic morbidity less than 1% and mortality less than 0.1% per year. Primary events were stroke and death in the period between randomization and 30 days after surgery; secondary events were transient ischemic attack and myocardial infarction occurring in the same period.
  
  
  RESULTS
  Of the 721 patients who underwent CEA, 1 died and 10 others had strokes within 30 days (1.5%). Of the 415 who underwent arteriography after randomization but before CEA, 5 (1.2%) suffered transient ischemic attack or stroke caused by arteriography. Thus, a nearly equal risk of stroke was associated with both CEA and carotid arteriography. In addition, 6 transient ischemic attacks and 3 myocardial infarctions could be directly linked to CEA, for a total CEA event rate of 2.6%.
  
  
  CONCLUSIONS
  Patients with asymptomatic internal carotid artery stenosis exceeding 60% reduction in diameter who are acceptable candidates for elective operation may be considered for CEA if the combined arteriographic and surgical complication rates are 3% or less.
authors.affiliation: Albert B. Chandler Medical Center, Lexington, Ky, USA.
authors.forename: B
authors.initials: B
authors.lastname: Young
authors.forename: W S
authors.initials: WS
authors.lastname: Moore
authors.forename: J T
authors.initials: JT
authors.lastname: Robertson
authors.forename: J F
authors.initials: JF
authors.lastname: Toole
authors.forename: C B
authors.initials: CB
authors.lastname: Ernst
authors.forename: S N
authors.initials: SN
authors.lastname: Cohen
authors.forename: J P
authors.initials: JP
authors.lastname: Broderick
authors.forename: R J
authors.initials: RJ
authors.lastname: Dempsey
authors.forename: J D
authors.initials: JD
authors.lastname: Hosking
mesh_terms: D000758:Anesthesia; D001161:Arteriosclerosis / Q000401:mortality / Q000601:surgery*; D001241:Aspirin / Q000627:therapeutic use; D016893:Carotid Stenosis / Q000401:mortality / Q000601:surgery*; D002544:Cerebral Infarction / Q000401:mortality / Q000517:prevention & control*; D003131:Combined Modality Therapy; D003391:Cranial Nerves / Q000503:physiopathology; D003645:Death, Sudden / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology; D017558:Elective Surgical Procedures / Q000401:mortality; D016894:Endarterectomy, Carotid / Q000401:mortality; D006331:Heart Diseases / Q000150:complications; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D002546:Ischemic Attack, Transient / Q000453:epidemiology / Q000517:prevention & control*; D009203:Myocardial Infarction / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000401:mortality*; D011446:Prospective Studies; D012907:Smoking / Q000453:epidemiology; D013695:Temperance / Q000706:statistics & numerical data
chemical_list: D001241:Aspirin