[Asymptomatic carotid stenoses. Analysis of randomized studies]

Abstract

Results of recent randomized clinical trials in patients with asymptomatic carotid artery stenosis have progressively tended towards a more surgical than medical attitude to treatment. Interim results of the Veterans Administration study of 444 patients randomly allocated to receive either aspirin (233 cases) or surgery (211 cases) showed the percentage of vascular accidents and postoperative mortality to be 2.4% and 1.9% respectively in the surgical group, a marked reduction when compared with the 5% neurologic events reported in the medical group. In contrast, results of the Casanova Study, an equally randomized trial of 410 patients, 344 of whom underwent carotid endarterectomy, failed to demonstrate a significant difference in neurologic events or mortality between the two groups, although these were not homogeneous. Finally, the randomized French study (AURC) in 230 patients (135 operated upon and 109 treated medically with aspirin) showed a reduction in neurologic accidents in the surgical group, significant after a follow up of about 45 months. This tendency towards a surgical approach implies a low surgical morbidity/mortality, now possible due to local and regional plexus anesthesia monitoring, which carries a morbidity of less than 2% and a practically inexistent mortality.