[Carotid endarterectomy indicated in asymptomatic stenosis].
Carotid endarterectomy (CE) is of proven value for patients with a high-grade symptomatic stenosis of the internal carotid artery (ICA). Recently, the Asymptomatic Carotid Atherosclerosis Study group showed that in patients with an asymptomatic ICA stenosis of more than 60%, CE caused an absolute risk reduction of perioperative death or stroke during 5 year follow-up of 5.4% (95% confidence interval: 3.0-7.8). Half of these strokes were disabling. The number needed to treat to save one patient from death within 30 days or stroke within in the following 5 years was 19. Further studies are needed to isolate a group of patients that will substantially benefit from the operation. CE is probably most effective in males under 75 years of age. A low surgical morbidity and mortality is an absolute prerequisite to justify CE for an asymptomatic ICA stenosis.
Boiten
J
J
St. Jans Gasthuis, afd. Neurologie, Weert.
Algra
A
A
Moll
F L
FL
van de Pavoordt
H D W M
HD
Kappelle
L J
LJ
D000367:Age Factors; D000368:Aged; D002343:Carotid Artery, Internal / Q000601:surgery; D016893:Carotid Stenosis / Q000601:surgery*; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000517:prevention & control; D016894:Endarterectomy, Carotid / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D012307:Risk Factors; D012737:Sex Factors