Carotid endarterectomy for asymptomatic carotid stenosis: a meta-analysis.
OBJECTIVE
To assess the value of carotid endarterectomy for prevention of stroke in patients with asymptomatic carotid stenosis.


METHODS
Systematic review and meta-analysis of randomised controlled trials in patients with asymptomatic carotid stenosis in which subjects were allocated to carotid endarterectomy or to medical treatment alone.


METHODS
Five trials enrolled 2440 patients with stenosis >/ 50%.


METHODS
Stroke ipsilateral to the stenosis, all strokes, and perioperative complications (stroke or death).


RESULTS
In patients who underwent carotid endarterectomy (n=1215) there was a significant reduction in the odds of ipsilateral stroke plus perioperative stroke or death (odds ratio 0.62; 95% confidence interval 0.44 to 0.86), corresponding to a 2% absolute risk reduction over about 3.1 years. The prevalence of stroke in any location was also reduced (0.68; 0.51 to 0.9) in patients undergoing carotid endarterectomy. During the immediate postoperative period there was an increased prevalence of stroke or death among such patients (4.51; 2.36 to 8.64).


CONCLUSIONS
Carotid endarterectomy in patients with asymptomatic carotid stenosis unequivocally reduces the incidence of ipsilateral stroke, though the absolute benefit is relatively small. Given the modest benefit of surgery for unselected patients with asymptomatic carotid artery stenosis carotid endarterectomy cannot be routinely recommended for these patients pending reliable identification of high risk subgroups, and medical management is a sensible alternative for most patients.
Benavente
O
O
Department of Medicine, Division of Neurology, University of Texas Health Science Center, San Antonio, TX 78284-7883, USA. benavente@uthscsa.edu
Moher
D
D
Pham
B
B
D000368:Aged; D016893:Carotid Stenosis / Q000601:surgery*; D002561:Cerebrovascular Disorders / Q000517:prevention & control*; D016894:Endarterectomy, Carotid / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic / Q000379:methods / Q000592:standards; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016896:Treatment Outcome