Premium
Asymptomatic carotid stenosis: how should it be managed?
Author(s) -
Hankey Graeme J
Publication year - 1995
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.1995.tb124522.x
Subject(s) - asymptomatic , carotid endarterectomy , medicine , stenosis , stroke (engine) , endarterectomy , surgery , cardiology , carotid stenting , mechanical engineering , engineering
Objective To discuss the implications of recent studies on carotid endarterectomy for asymptomatic carotid stenosis. Data sources Trials of the effectiveness of carotid endarterectomy in asymptomatic carotid stenosis, including the Asymptomatic Carotid Atherosclerosis Study (ACAS). Results In the ACAS study, carotid endarterectomy for asymptomatic moderate to severe carotid stenosis (60%‐99% luminal obstruction) reduced the absolute risk of ipsilateral stroke or death at five years by 5.9%. This means that about 17 patients need to be operated on to prevent one stroke or death over five years. To operate on all Australians with asymptomatic 60%‐99% carotid stenosis would cost an estimated $ A 1.24 billion and prevent 800 strokes per year, or only 3% of all first strokes in Australia. Recommendations In order to identify who will benefit from carotid endarterectomy and who will remain symptom‐free without it, patients should continue to be allocated to the ongoing Asymptomatic Carotid Surgery Trial. Otherwise, carotid endarterectomy should be reserved for patients at high risk of stroke (i.e., with 95%‐99% carotid stenosis) who are medically fit for surgery and willing to take the small short term risk of surgery for a possible greater long term benefit.