Benefit of Carotid Endarterectomy in Patients with Symptomatic Moderate or Severe Stenosis
Carotid endarterectomy (CEA) has been proven effective for prevention of stroke in symptomatic persons with severe (more than 70%) stenosis. To date, duration of benefit has been demonstrated to be at least two years. Whether less severe stenosis in symptomatic persons merits surgical intervention is a persistent question, as well as the anticipated duration of benefit in those with greater degrees of stenosis.
The current study examined symptomatic persons (n = 2226) with 50-69% carotid stenosis who were stratified to receive either CEA or standard medical therapy. Subjects were followed for five years. An additional arm of the study evaluated the eight-year outcome of CEA in persons with severe stenosis.
CEA in moderate stenosis was associated with a 23% relative reduction in risk of any stroke or death. In patients with severe stenosis, eight years after CEA benefit for stroke reduction was still greater than 20% when compared to medical therapy.
Barnett and colleagues acknowledge that outcomes in the hands of clinicians at other sites may be modified by surgical skill and experience but conclude that benefits for both moderate and severe stenosis are substantial and enduring when compared with medical therapy.
Barnett HJ, Taylor DW, et al. N Engl J Med 1998;339:1415-1425.
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