Influence of NASCET/ACAS trial eligibility on outcome after carotid endarterectomy

Sternbergh, W. C., Tonnessen, B. and Money, S. R. (2001) Influence of NASCET/ACAS trial eligibility on outcome after carotid endarterectomy. Journal of Vascular Surgery, 34 4: 581-586. doi:10.1067/mva.2001.118079


Author Sternbergh, W. C.
Tonnessen, B.
Money, S. R.
Title Influence of NASCET/ACAS trial eligibility on outcome after carotid endarterectomy
Journal name Journal of Vascular Surgery   Check publisher's open access policy
ISSN 0741-5214
Publication date 2001-10
Sub-type Article (original research)
DOI 10.1067/mva.2001.118079
Volume 34
Issue 4
Start page 581
End page 586
Total pages 6
Place of publication Philadelphia, PA, United States
Publisher Mosby
Language eng
Formatted abstract
Purpose: Proponents of carotid angioplasty and stenting suggest that "high risk" patients, defined as patients excluded from the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and Asymptomatic Carotid Atherosclerosis Study (ACAS), may have a significantly higher risk of stroke with carotid endarterectomy (CEA). However, this selected patient cohort has been poorly studied.

Methods: A retrospective review of patients who underwent CEA during a 2-year period at a tertiary referral institution was performed. Each patient was evaluated and categorized, according to the exclusion criteria, by NASCET and ACAS standards. Statistical analysis using chi (2) and Fisher exact tests was performed.

Results: There were 366 CEAs performed on 348 patients, including 32 (8.7%) for recurrent stenosis. A subgroup of 169 (46.2%) patients were trial ineligible. Focal ipsilateral symptoms were present in 148 (40.4%) of the patients. There were 9 (2.5%) strokes and 1 (0.3%) death, secondary to a major stroke, for an overall stroke and death rate of 2.5%. Trial-eligible patients had a stroke/death rate of 1.5% (3/197) while trial-ineligible patients had a 3.6% (6/169) stroke/death rate (P =.17).

Conclusion: Patients who were considered high risk for CEA as defined by trial ineligibility were common, comprising approximately half of our patients. Although trial-ineligible patients had a nonsignificant trend toward higher neurologic morbidity when compared with the eligible group, the risks were still comparable with NASCET/ACAS results. CEA was a safe procedure even in this "high risk" group. As such, ineligibility for a randomized carotid intervention trial should not be employed as a "de novo" indication for carotid stenting.
Keyword Population
Experience
Mortality
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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Created: Mon, 14 Mar 2011, 10:02:14 EST