[Indications for endarterectomy in asymptomatic stenoses of the internal or common carotid artery--results of the North American ACAS Study].
OBJECTIVE
To determine the effect of endarterectomy on the primary prevention of ischemic stroke in patients with asymptomatic carotid artery stenosis.


METHODS
In a prospective, randomized, multicenter trial 1659 patients with asymptomatic carotid stenosis of 60% or more were studied in two treatment arms (endarterectomy: n = 825; medical therapy: n = 834). Endpoints were: (1) ischemic stroke in the vascular territory of the study artery, (2) any perioperative stroke or any perioperative death.


RESULTS
The Kaplan-Meier 5-year-risk estimation showed a relative risk reduction of 53% (confidence interval: 22%-72%) for patients in the surgical arm. The combined perioperative morbidity and mortality rate was 2.3%.


CONCLUSIONS
Endarterectomy of asymptomatic carotid artery stenosis performed with a perioperative complication rate of less than 3% reduces the 5-year risk of ipsilateral stroke.
Mast
H
H
Neurologische Abteilung, Neurovaskuläre Einheit, Universitätsklinikum Benjamin Franklin, Freien Universität, Berlin.
Chambless
L E
LE
Mohr
J P
JP
Toole
J F
JF
D000328:Adult; D000368:Aged; D016893:Carotid Stenosis / Q000401:mortality / Q000601:surgery*; D002561:Cerebrovascular Disorders / Q000401:mortality / Q000517:prevention & control*; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control*; D011446:Prospective Studies; D012306:Risk; D015996:Survival Rate; D016896:Treatment Outcome
Zur Indikation der Endarterektomie bei asymptomatischen Stenosen der Arteria carotis interna oder communis--die Ergebnisse der nordamerikanischen ACAS-Studie.