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Results of a Randomized Controlled Trial of Carotid Endarterectomy for Asymptomatic Carotid Stenosis

  • MAYO ASYMPTOMATIC CAROTID ENDARTERECTOMY STUDY GROUP
    Author Footnotes
    * The members of the group are listed in the Appendix, page 518.
  • Author Footnotes
    * The members of the group are listed in the Appendix, page 518.
      We undertook a randomized controlled trial designed to compare the effects of carotid endarterectomy with medical treatment using low-dose aspirin in patients with asymptomatic carotid stenosis. During 30 months of recruitment, 71 randomized and 87 eligible nonrandomized patients participated in a follow-up protocol. The total ipsilateral perioperative stroke and death rate was 0% among randomized patients and 3% among nonrandomized patients, and the major stroke and death rate was 0% for both groups. Too few cerebral ischemic events occurred to judge the comparative effectiveness of carotid endarterectomy versus low-dose aspirin for asymptomatic carotid stenosis. The trial was terminated early because of a significantly higher number of myocardial infarctions and transient cerebral ischemic events in the surgical group than in the medical group. Most of the events were not temporally related to the surgical procedure, but there was evidence that these events could have related to the absence of aspirin use in the surgical group. These observations reinforce the appropriateness of the use of aspirin throughout the perioperative period and beyond (unless contraindications exist) in patients with asymptomatic carotid stenosis who undergo carotid endarterectomy.
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      REFERENCES

        • Clagett GP
        • Youkey JR
        • Brigham RA
        • Orecchia PM
        • Salander JM
        • Collins Jr, GJ
        • Rich NM
        Asymptomatic cervical bruit and abnormal ocular pneumoplethysmography: a prospective study comparing two approaches to management.
        Surgery. 1984; 96: 823-830
        • Winslow CM
        • Solomon DH
        • Chassin MR
        • Kosecoff J
        • Merrick NJ
        • Brook RH
        The appropriateness of carotid endarterectomy.
        N Engl J Med. 1988; 318: 721-727
        • Mayo Asymptomatic Carotid Endarterectomy Study Group
        Effectiveness of carotid endarterectomy for asymptomatic carotid stenosis: design of a clinical trial.
        Mayo Clin Proc. 1989; 64: 897-904
      1. Carotid Artery Surgery Trialist Group: Comparison of multicenter study designs for investigation of the efficacy of carotid endarterectomy. Stroke (in press)

        • Veterans Administration Cooperative Study
        Role of carotid endarterectomy in asymptomatic carotid stenosis.
        Stroke. 1986; 17: 534-539
        • Diener HC
        • Hamann H
        Prospective studies for the evaluation of carotid surgery versus medical therapy in neurologically asymptomatic patients.
        in: Hennerici M Sitzer G Weger H-D Carotid Artery Plaques: Pathogenesis, Development, Evaluation, Treatment. Bertelsmann Foundation, Gütersloh, Germany1988: 273-282
        • CASANOVA Study Group
        Carotid surgery versus medical therapy in asymptomatic carotid stenosis.
        Stroke. 1991; 22: 1229-1235