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Evidence summaries

Carotid Endarterectomy for Asymptomatic Carotid Stenosis

Carotid endarterectomy for asymptomatic carotid stenosis reduces the risk of strokes by approximately 30% over three years but the absolute risk reduction is small and would be negated by a higher perioperative complication rate. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 3 studies with a total of 5 223 subjects with asymptomatic carotid stenosis, irrespective of degree of stenosis or the method of determining the degree of stenosis.

For the primary outcome of perioperative stroke or death or any subsequent stroke, patients undergoing carotid endarterectomy (CEA) fared better than those treated medically (relative risk [RR] 0.69, 95% confidence interval [CI] 0.57 to 0.83). Similarly, for the outcome of perioperative stroke or death or subsequent ipsilateral stroke, there was benefit for the surgical group (RR 0.71, 95% CI 0.55 to 0.90). For the outcome of any stroke or death, there was a non-significant trend towards fewer events in the surgical group (RR 0.92, 95% CI 0.83 to 1.02). The overall net excess of operation-related perioperative stroke or death was 2.9%.

    References

    • Chambers BR, Donnan GA. Carotid endarterectomy for asymptomatic carotid stenosis. Cochrane Database Syst Rev 2005 Oct 19;(4):CD001923. [PubMed]

Primary/Secondary Keywords