[Endarterectomy should not be offered routinely to patients with asymptomatic carotid stenosis].
A recent trial revealed a reduction in ischaemic infarcts after carotid endarterectomy in patients with asymptomatic carotid stenosis. However, the number needed to treat (NNT) was 19 to prevent one stroke in 5 years, a modest effect in comparison to the trials with symptomatic patients (a NNT of only 6 in patients with a symptomatic stenosis of 70-99%). Furthermore, the number of surgical complications outweighs the benefits of surgery during the first two years after treatment. Finally, the benefits also included the prevention of contralateral strokes, whereas it is unlikely that these are prevented by endarterectomy. Therefore, endarterectomy should not be performed routinely in asymptomatic persons.
Nederkoorn
P J
PJ
Academisch Medisch Centrum/Universiteit van Amsterdam, afd. Neurologie, Postbus 22.660, 1100, DD Amsterdam. p.j.nederkoorn@amc.uva.nl
Stam
J
J
D016893:Carotid Stenosis / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000379:methods*; D006801:Humans; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*