The North American Symptomatic Carotid Endarterectomy Trial
نویسندگان
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. (Stroke. 1999;30:1751-1758.)
منابع مشابه
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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...
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| 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.
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References 1. European Carotid Surgery Trialists' Group: MRC European Carotid Surgery Trial: Interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis. Lancet 1991^37:1235-1243 2. North American Symptomatic Carotid Endarterectomy Trial Collaborators: Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N ...
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