title: Modern medical treatment with or without carotid endarterectomy for severe asymptomatic carotid atherosclerosis.
abstract: OBJECTIVE
  This study assessed the value of modern medical treatment (MMT) with and without carotid endarterectomy (CEA) in patients with asymptomatic severe carotid artery stenosis.
  
  
  METHODS
  We conducted a randomized trial involving 55 patients with 70% to 79% carotid stenosis at three Russian centers. Between 2009 and 2013, 31 patients were randomized to undergo CEA with MMT (CEA group) and 24 to receive MMT alone. The primary end point was nonfatal ipsilateral stroke or death from any cause during a follow-up period of 5.0 years. The secondary end point was any nonfatal stroke, carotid revascularization, or death from any cause during follow-up.
  
  
  RESULTS
  The trial was stopped after a median follow-up of 3.3 years (maximum, 5.0 years). There were two primary events in the CEA group and nine events in the MMT group. The 3.3-year cumulative primary event rates were 6.5% in the CEA group and 37.5% in the MMT group (hazard ratio for the MMT group, 5.06; 95% confidence interval, 1.53-16.79; P = .008). The 3.3-year cumulative secondary end point was 12.9% in the CEA group and 50.0% in the MMT group (hazard ratio for the MMT group, 4.23; 95% confidence interval, 1.55-11.53; P = .0048).
  
  
  CONCLUSIONS
  CEA as an initial management strategy could reduce the risk of death and major cerebrovascular events when added to MMT.
authors.affiliation: Department of Clinical Cardiology and Molecular Genetics, National Research Center for Preventive Medicine, Moscow, Russian Federation. Electronic address: docsn173@yandex.ru.
authors.forename: Igor
authors.initials: I
authors.lastname: Kolos
authors.affiliation: Department of Vascular Surgery, Federal Medical and Biological Agency, Moscow, Russian Federation.
authors.forename: Alexandr
authors.initials: A
authors.lastname: Troitskiy
authors.affiliation: Department of Vascular Ultrasound, Russian Cardiology Research and Production Center, Moscow, Russian Federation.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Balakhonova
authors.affiliation: Department of Tomography, Russian Cardiology Research and Production Center, Moscow, Russian Federation.
authors.forename: Merab
authors.initials: M
authors.lastname: Shariya
authors.affiliation: Department of Vascular Surgery, Regional Clinical Hospital No. 1, Krasnodar, Russian Federation.
authors.forename: Denis
authors.initials: D
authors.lastname: Skrypnik
authors.affiliation: Neurology Department, National Research Center for Preventive Medicine, Moscow, Russian Federation.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Tvorogova
authors.affiliation: Laboratory of Biostatistics, National Research Center for Preventive Medicine, Moscow, Russian Federation.
authors.forename: Alexandr
authors.initials: A
authors.lastname: Deev
authors.affiliation: Department of Clinical Cardiology and Molecular Genetics, National Research Center for Preventive Medicine, Moscow, Russian Federation.
authors.forename: Sergey
authors.initials: S
authors.lastname: Boytsov
mesh_terms: D000368:Aged; D017311:Amlodipine / Q000008:administration & dosage; D001161:Arteriosclerosis / Q000628:therapy*; D000069059:Atorvastatin / Q000008:administration & dosage; D002340:Carotid Artery Diseases / Q000628:therapy*; D016894:Endarterectomy, Carotid; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006852:Hydrochlorothiazide / Q000008:administration & dosage; D008019:Life Style; D008297:Male
chemical_list: D006852:Hydrochlorothiazide; D017311:Amlodipine; D000069059:Atorvastatin