Cs. Cina et al., Refining the indications for carotid endarterectomy in patients with symptomatic carotid stenosis: A systematic review, J VASC SURG, 30(4), 1999, pp. 606-617
Citations number
46
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Objective: The purpose of this study was to summarize the existing literatu
re on the efficacy of carotid endarterectomy in patients with ipsilateral s
ymptomatic carotid stenosis.
Methods: Database searching, relevance assessment, methodologic quality ass
essments, and data extraction were all performed in duplicate with prespeci
fied criteria.
Results: Twenty-three publications were identified from the North American
Symptomatic Carotid Endarterectomy Trial, the European Carotid Surgery Tria
l, and the Veterans Affairs Cooperative Studies Program. Stenosis was repor
ted as measured in the North American Symptomatic Carotid Endarterectomy Tr
ial. In patients with >70% stenosis, carotid endarterectomy was associated
with a pooled relative risk reduction of 48% (95% confidence interval [CI],
27% to 73%) and an absolute risk reduction of 6.7% (95% CI, 3.2% to 10%) f
or the outcome of death or major disability from stroke. This translates in
to a number needed to treat of 15 (95% CI, 10 to 31). For patients with 50%
to 69% stenosis, the benefit of surgery was less and the confidence interv
als were wider. A relative risk reduction of 27% (95% CI, 5% to 44%), an ab
solute risk reduction of 4.7% (95% CI, 0.8% to 8.7%), and a number needed t
o treat of 21 (95% CI, 11 to 125) were observed in this group. The patients
with the lowest degrees of stenosis (<50%) were harmed by the intervention
(number needed to harm, 45). Increasing degree of stenosis, increasing age
, male sex, the presence of other medical risk factors, and the presence of
hemispheric rather than retinal antecedent events were factors that increa
sed the benefits from surgery.
Conclusion: Carotid endarterectomy reduced death or major disability from s
troke in patients with >50% symptomatic stenosis. To maximize the benefits
of surgery, careful preoperative risk assessment and the maintenance of low
rates of major perioperative complications are mandatory.