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Carotid Endarterectomy Tied to Long-Term Stroke Reduction

Last Updated: September 24, 2010.

Carotid endarterectomy performed in asymptomatic patients under 75 years of age appears to reduce 10-year stroke risks, with half this reduction in disabling or fatal strokes, according to a study published in the Sept. 25 issue of The Lancet.

FRIDAY, Sept. 24 (HealthDay News) -- Carotid endarterectomy (CEA) performed in asymptomatic patients under 75 years of age appears to reduce 10-year stroke risks, with half this reduction in disabling or fatal strokes, according to a study published in the Sept. 25 issue of The Lancet.

Between 1993 and 2003, Alison Halliday, of John Radcliffe Hospital in Oxford, U.K., and colleagues randomized 3,120 asymptomatic patients to immediate CEA (median delay one month) or to indefinite deferral of any carotid procedure. They followed the patients until death or, among survivors, for a median of nine years.

The investigators found that the proportions operated on while still asymptomatic at one year were 89.7 percent in the immediate CEA group and 4.8 percent in the deferral group. At five years, the proportions were 92.1 and 16.5 percent, respectively. Stroke risks, excluding perioperative events and non-stroke mortality, were 4.1 percent in the immediate CEA group and 10 percent in the deferral group at five years, and 10.8 and 16.9 percent, respectively, at 10 years. Combining perioperative events and strokes, the net risks were 6.9 percent in the immediate CEA group and 10.9 percent in the deferral group at five years, and 13.4 and 17.9 percent, respectively, at 10 years. The researchers also found that net benefits were significant for both those on and those not on lipid-lowering therapy, as well as for both men and women up to 75 years of age at study entry.

"Evidence that endarterectomy reduces stroke more effectively than stents in people with carotid stenosis is strengthened by two articles: the Carotid Stenting Trialists' Collaboration's meta-analysis of short-term outcomes in symptomatic disease, and a long-term follow-up from the Asymptomatic Carotid Surgery Trial. These studies are a testament to the value of time and volume to clarify surgical outcomes," write the authors of an accompanying editorial.

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