ASYMPTOMATIC CAROTID ENDARTERECTOMY PATIENT AND SURGEON SELECTION

Background and Purpose The applicability of prospective carotid endart erectomy protocols to the general population has been questioned. Outc omes for asymptomatic patients undergoing carotid endarterectomy were compared with the results of the Asymptomatic Carotid Atherosclerosis Study (ACAS) patients treated concurrently at our institution. Methods Asymptomatic patients undergoing carotid endarterectomies (n=277) fro m 1987 to 1993 (ACAS enrollment period) were reviewed. Primary end poi nts were mortality, myocardial infarction, and stroke. Five subgroups were studied: (1) ACAS surgical patients; (2) ACAS-eligible patients n ot enrolled and ACAS surgeons; (3) ACAS-eligible patients not enrolled and non-ACAS surgeons; (4) ACAS-ineligible patients and ACAS surgeons ; and (5) ACAS-ineligible patients and non-ACAS surgeons. Results ACAS -eligible patients were younger (P=.014), had more severe carotid sten osis (P=.001), and had lower incidences of pulmonary (P=.015) and rena l (P=.008) diseases compared with ineligible patients. Patient selecti on (ACAS eligibility) significantly improved outcomes for mortality (P =.014) and myocardial infarction (P=.006). Length of stay favored ACAS -eligible patients (P=.004). ACAS surgeons operated on more severely s tenotic carotid lesions (P=.005) and on patients with a lower incidenc e of coronary artery disease (P=.007). There was no difference in outc omes between ACAS and non-ACAS sur eons. Conclusions Patient selection was a significant factor in determining outcome. With strict adherenc e to ACAS enrollment guidelines, the conclusions of ACAS appear applic able to patients seen at our institution with asymptomatic carotid ste nosis.