Author/Editor		Mansfield, A; Marro, J; Peto, C; Peto, R; Potter, J; Thomas, D; Flis, V; Miksić, K; Stirn, B; Tetičkovič, E
Title		Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial
Type		članek
Source		Lancet
Vol. and No.		Letnik 363
Publication year		2004
Volume		str. 1491-1502
Language		eng
Abstract		Background Among patients with substantial carotid artery narrowing but no recent neurological symptom (stroke or transient ischaemia), the balance of surgical risks and iongterm benefits from carotid endarterectomy (CEA) was unclear. Methods During 1993-2003, 3120 asymptomatic patients with substantial carotid narrowing were randomised equally between immediate CEA (half got CEA by 1 month, 88% by 1 year) and indefinite deferral of any CEA (only 4% per year got CEA) and were followed for up to 5 years (mean 3-4 years). Kaplan-Meier analyses of 5-year risks are by allocated treatment. Findings The risk of stroke or death within 30 days of CEA was 3-1% (95% CI 2-3-4-1). Comparing all patients allocated immediate CEA versus all allocated deferral, but excluding such periopsrative events, the 5-year stroke risks were 3-8% versus 11% (gain 7-2% [95% CI 5-0-9-4], p<0-0001). This gain chiefly involved carotid territory ischaemic strokes (2-7% vs 9-5%; gain 6-8% [4-8-8-8], p<0-0001), of which half were disabling or fatal (1-8% vs 5-3%; gain 3-7% [2-1-5-2], p<0-0001), as were half the perioperative strokes. Combining the perioperative events and the non-perioperative strokes, net 5-year risks were 8-4% versus 11-8% for all strokes (net gain 5-4% [3-0-7-8], p<0-0001), 3-5% versus 6-1% for fatal or disabling strokes (net gain 2-5% [0-8-4-3], p=0-004), and 2-1% versus 4-2% just for fatal strokes (net gain 2-1% [0-6-3-6], p=0-006). Subgroup-specific analyses found no significant heterogeneity in the perioperative hazards or (apart from the importance of cholesterol) in the long-term postoperative benefits. These benefits were separately significant for males and females; for those with about 70%, 80%, and 90% carotid artery narrowing on ultrasound: and for those younger than 65 and 65-74 years of age (though not for older patients, half of whom die within 5 years from unrelated causes). (Abstract truncated at 2000 characters).
Descriptors		CAROTID STENOSIS CEREBROVASCULAR DISORDERS ENDARTERECTOMY, CAROTID CEREBRAL ISCHEMIA, TRANSIENT SURVIVAL RATE RISK FACTORS AGED SEX FACTORS TIME FACTORS