COMPARISON OF -AMERICAN-SYMPTOMATIC-CAROTID-ENDARTERECTOMY-TRIAL AND POPULATION-BASED OUTCOMES FOR CAROTID ENDARTERECTOMY

Purpose: The North American Symptomatic Carotid Endarterectomy Trial ( NASCET) advocated the use of carotid endarterectomy (CEA) for transien t ischemic attacks (TIAs), nondisabling strokes, and ipsilateral high- grade stenosis in highly selected patients. Whether similar results ar e achieved when CEA is applied to an entire geographically defined pop ulation is unknown but important if the NASCET recommendations are to be applied broadly to all community patients. Methods: To determine th e survival rate to ipsilateral stroke after CEA for all symptomatic pa tients in a defined population, we reviewed the medical records of ail patients residing in Olmsted County, Minn. (approximately 100,000), w ho underwent a CEA for TIA or nondisabling stroke between 1970 and 199 5. Their outcomes were compared with the NASCET results. Results: In t he community of Olmsted County, 297 patients (108 women and 189 men) u nderwent 322 CEAs during the study period. TIAs or nondisabling stroke was the indication in 254 patients (86%), whereas the remaining 14% h ad asymptomatic stenosis. After CEA for symptomatic lesions, survival rate free of ipsilateral stroke was 97% at 2 years, 93% at 5 years, an d 92% at 10 years. These results are similar to the NASCET survival ra tes free of ipsilateral stroke at 2 years (91%). However, the 30-day p ostoperative stroke rate for patients older than 80 years was signific antly higher than that for patients younger than 80 years. Conclusions : When the NASCET results are compared with a population-based experie nce in which all symptomatic patients undergoing CEA were analyzed, th e early outcomes were similar. Our population-based data also document the remarkably durable long-term results of CEA in preventing stroke and present another benchmark for carotid stent angioplasty.