Analysis of the effect of asymptomatic carotid atherosclerosis study on the outcome and volume of carotid endarterectomy

Recent studies have demonstrated the benefits of carotid endarterectomy (CE A) and risk factor control in preventing stroke in asymptomatic patients, I n this study, the effect of the asymptomatic carotid atherosclerosis study (ACAS) on the frequency of CEAs performed and the outcome of such procedure s on symptomatic and asymptomatic patients were analyzed. From 1990 to 1996, all patients undergoing CEA were prospectively entered i nto a computerized vascular registry. The number of procedures, indications , demographics, and early and late results were analyzed and compared with similar data compiled prior to the ACAS study. The total volume of CEAs performed increased from 66 in 1990 to 719 in 1996 (ratio 1:12.3). The ratio of symptomatic to asymptomatic patients changed from 1.75:1 in 1990 to 1:1.52 in 1996, The combined stroke/mortality rate d ropped from 4.75% in 1990 to 2.15% in 1996, The stroke mortality in the asy mptomatic group decreased significantly from 4.3 to 1.9% in the pre and pos t-ACAS groups respectively (P < 0.0005), The stroke mortality of symptomati c patients remained constant at 2.1 and 1.4% respectively. Since the completion of ACAS in 1993, the number of CEAs performed on our s ervice has increased tenfold. An increase in Volume has translated into an improved stroke/mortality rate and significantly decreased length of stay, (C) 2000 The international Society for Cardiovascular Surgery. Published by Elsevier Science Ltd. All rights reserved.