Carotid endarterectomy, individual...

Carotid endarterectomy, individual of the most frequently performed vascular surgeries, has been associated with significant reductions in rates of ischemic calamity in at least two large randomized controll trials. Initial inferences indicated that endarterectomy was beneficial simply in patients with stenosis of 70 percent or more. The surgery converses no benefit in patients with 30 to 49 percent stenosis and does more harm than benefit when stenosis is les than 30 percent Rothwell and colleagues examined subgroup of patients to determine which factors, in addition to the measure of arterial stenosis, would indicate the possibility of benefit from endarterectomy.

They collection of standing watered data from the two largest randomized controll trials, the European Carotid Surgery Trial and the North American Symptomatic Carotid Endarterectomy Trial, which together included 95 percent of patients for aye randomized in trials of this surgery The participants had experienced new clinical events in the distribution of the carotid artery, and the symptomatic sailing craft was imaged by selective catheter angiography. Participants were randomized to medical or surgical treatment, and follow-up was directioned by neurologists or by subspecialists in stroke

Follow-up data were obtained for 5893 patients across an average of 66 month Of the 3157 patients treated with endarterectomy, 222 (7 percent) had operative deaths or attacks The perioperative risk of death or knock was increased in women, patients with diabetes, patients with occlusion of the other carotid artery, patients with ulcerated or irregular plaques, and patients who had hemispheric (rather than retinal) occurrences preceding clinical events. Age, sex and time since last symptomatic affair greatly modified the outcome of surgery When all variables were included in the analysis, the benefits from surgery were greatest in men patients older than 75 years, and those who had surgery within sum of two units weeks of their last ischemic event

The authors calculate that the number extremityed to treat (NNT) with carotid endarterectomy to avoid the same ipsilateral stroke within five years was nine among men and 36 among women in patients with stenosis of 50 percent or greater. The comparable NNT was five among patients older than 75 years compared with 18 among those younger than 65 years, and five among those randomized within brace weeks of an ischemic marked occurrence compared with 125 among those randomized more than 12 weeks after the affair They stress that additional factors besides the extent of stenosis must be considered when advising patients and families about carotid endarterectomy. Among these factors, delay in surgery appears to be the greatest in quantity significant. Ideally, carotid endarterectomy should be performed within pair weeks of the ischemic episode.

Rothwell PM et al. Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroup and timing of surgery Lancet March 20 2004;363:915-24

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