The North American Symptomatic Carotid Endarterectomy Trial : surgical results in 1415 patients.

نویسندگان

  • G G Ferguson
  • M Eliasziw
  • H W Barr
  • G P Clagett
  • R W Barnes
  • M C Wallace
  • D W Taylor
  • R B Haynes
  • J W Finan
  • V C Hachinski
  • H J Barnett
چکیده

BACKGROUND AND PURPOSE This study reports the surgical results in those patients who underwent carotid endarterectomy in the North American Symptomatic Carotid Endarterectomy Trial (NASCET). METHODS The rates of perioperative stroke and death at 30 days and the final assessment of stroke severity at 90 days were calculated. Regression modeling was used to identify variables that increased or decreased perioperative risk. Nonoutcome surgical complications were summarized. The durability of carotid endarterectomy was examined. RESULTS In 1415 patients there were 92 perioperative outcome events, for an overall rate of 6.5%. At 30 days the results were as follows: death, 1.1%; disabling stroke, 1.8%; and nondisabling stroke, 3.7%. At 90 days, because of improvement in the neurological status of patients judged to have been disabled at 30 days, the results were as follows: death, 1.1%; disabling stroke, 0.9%; and nondisabling stroke, 4.5%. Thirty events occurred intraoperatively; 62 were delayed. Most strokes resulted from thromboembolism. Five baseline variables were predictive of increased surgical risk: hemispheric versus retinal transient ischemic attack as the qualifying event, left-sided procedure, contralateral carotid occlusion, ipsilateral ischemic lesion on CT scan, and irregular or ulcerated ipsilateral plaque. History of coronary artery disease with prior cardiac procedure was associated with reduced risk. The risk of perioperative wound complications was 9.3%, and that of cranial nerve injuries was 8.6%; most were of mild severity. At 8 years, the risk of disabling ipsilateral stroke was 5.7%, and that of any ipsilateral stroke was 17.1%. CONCLUSIONS The overall rate of perioperative stroke and death was 6.5%, but the rate of permanently disabling stroke and death was only 2.0%. Other surgical complications were rarely clinically important. Carotid endarterectomy is a durable procedure.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Efficacy of carotid endarterectomy translates to being efficacious with appropriate surgical skill.

| FULL TEXT | PDF | MEDLINE 7.Barnett HJM, Taylor DW, Eliasziw M, et al, for the North American Symptomatic Carotid EndarterectomyTrial Collaborators.Benefit of carotid endarterectomy in symptomatic patients with moderate and severe stenosis.N Engl J Med.1998;339:1415-1425.

متن کامل

Predicting outcomes in CKD: the importance of perspectives, populations and practices.

72. European Carotid Surgery Trialists’ Collaborative Group. MRC European carotid surgery trial: interim results for symptomatic patients with severe carotid stenosis and with mild carotid stenosis. Lancet 1991; 337: 1235–1243 73. Ferguson GG, Eliasziw M, Barr HWK et al. The North American symptomatic carotid endarterectomy trial: surgical result in 1415 patients. Stroke 1999; 30: 1751–1758 74....

متن کامل

Primary Findings From Selected Recent National Institute of Neurological Disorders and Stroke-Sponsored Clinical Trials That Have shaped Modern Stroke Prevention

NORTH AMERICAN SYMPTOMATIC CAROTID ENDARTERECTOMY TRIAL The North American Symptomatic Carotid Endarterectomy Trial (NASCET) answered practical questions relating to the efficacy and safety of carotid endarterectomy based on degree of carotid stenosis and accompanying medical comorbidity in patients with symptomatic carotid stenosis (The Canadian Cooperative Study Group, 1998; North American Sy...

متن کامل

Point of View Carotid Endarterectomy is the Best Choice for Patients with Carotid Disease

The good long term outcome of carotid endarterectomy (CE) was recognized for the first time after publication of the seminal study by Prof. DeBakey in 19751. Since then, CE has been one of the most analyzed and investigated vascular surgical procedures. In the beginning of the 1990s, the results and surgical indications for carotid disease were well established for symptomatic patients with the...

متن کامل

The North American Symptomatic Carotid Endarterectomy Trial

Background and Purpose—This study reports the surgical results in those patients who underwent carotid endarterectomy in the North American Symptomatic Carotid Endarterectomy Trial (NASCET). Methods—The rates of perioperative stroke and death at 30 days and the final assessment of stroke severity at 90 days were calculated. Regression modeling was used to identify variables that increased or de...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:
  • Stroke

دوره 30 9  شماره 

صفحات  -

تاریخ انتشار 1999