Long-term results of medical and surgical therapy for Japanese patients with moderate carotid stenosis.
To clarify the efficacy of medication versus carotid endarterectomy (CEA), we investigated cardiovascular events and outcomes in Japanese patients with moderate carotid stenosis. We consecutively registered patients with significant carotid stenosis (50%-79%) measured by digital subtraction angiography (DSA) over 10 years and compared the incidences of stroke, myocardial infarction, and death between treatment groups (surgical group vs medical group). Of 406 registered patients, 163 (108 treated surgically and 55 treated medically) with moderate carotid stenosis were analyzed. Complete follow-up data (mean, 4.2 years) were available for 105 patients in the surgical group (97.2%) and 54 patients in the medical group (98.2%). Surgical treatment was associated with lower incidences of any stroke, myocardial infarction, and death compared with medication. Although the incidence rates differed significantly between CEA and medication in the 66 symptomatic patients, there were no significant differences in the 93 asymptomatic patients. The results of this single-center study in Japanese patients suggest that CEA is an acceptable treatment for patients with symptomatic moderate carotid stenosis, but that CEA for asymptomatic moderate carotid stenosis seems to be less effective in Japanese patients.
Ogata
Toshiyasu
T
Department of Cerebrovascular Disease, Cerebrovascular Center and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
Yasaka
Masahiro
M
Wakugawa
Yoshiyuki
Y
Inoue
Tooru
T
Yasumori
Kotaro
K
Kitazono
Takanari
T
Iida
Mitsuo
M
Okada
Yasushi
Y
D000368:Aged; D015901:Angiography, Digital Subtraction / Q000379:methods; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D016893:Carotid Stenosis / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D015897:Comorbidity / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality; D011446:Prospective Studies; D012042:Registries; D013995:Time; D016896:Treatment Outcome