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ENDARTERECTOMY HAS LITTLE VALUE IN ASYMPTOMATIC CAROTID STENOSIS.

Carotid endarterectomy is valuable in patients with symptomatic high-grade stenosis (see Journal Watch accession number 911224003). This large multicenter randomized trial from the Department of Veterans Affairs examined the procedure's value in 444 men with at least 50 percent stenosis on arteriography but no symptoms.

The patients averaged 64 years of age, and 87 percent were white. All received optimal medical management, including aspirin (650 mg twice daily), and half also underwent endarterectomy. During a mean follow-up of 48 months, the combined incidence of ipsilateral neurologic events (transient ischemic attack, transient monocular blindness, or stroke) differed significantly between the medical and surgical groups (21 percent vs. 8 percent). However, there were no significant differences in rates of ipsilateral stroke alone (9.4 percent vs. 4.7 percent), stroke or death combined (44 percent vs. 41 percent), or death or stroke within 30 days after randomization (1.3 percent vs. 4.7 percent).

Although the surgical patients had a lower risk of transient neurologic events, they had no reduction in death or permanent neurologic events, and nearly 5 percent suffered stroke or death within 30 days. An editorial concludes that carotid endarterectomy should have no place in the management of asymptomatic carotid stenosis until results are known from an ongoing, much larger randomized study of this question.

— ALK

Published in Journal Watch General Medicine January 29, 1993

Citation(s):

Barnett HJM; Haines SJ. Carotid endarterectomy for asymptomatic carotid stenosis. N Engl J Med 1993 Jan 28 328 276-279.

• Medline abstract (Free)

Hobson RW et al. Efficacy of carotid endarterectomy for asymptomatic carotid stenosis. N Engl J Med 1993 Jan 28 328 221-227.

• Medline abstract (Free)

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