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Meta-Analysis
. 1998 Nov 28;317(7171):1477-80.
doi: 10.1136/bmj.317.7171.1477.

Carotid endarterectomy for asymptomatic carotid stenosis: a meta-analysis

O Benavente  1 , D Moher, B Pham
Affiliations
Meta-Analysis

Carotid endarterectomy for asymptomatic carotid stenosis: a meta-analysis

O Benavente et al. BMJ. .

Abstract

Objective: To assess the value of carotid endarterectomy for prevention of stroke in patients with asymptomatic carotid stenosis.

Design: Systematic review and meta-analysis of randomised controlled trials in patients with asymptomatic carotid stenosis in which subjects were allocated to carotid endarterectomy or to medical treatment alone.

Subjects: Five trials enrolled 2440 patients with stenosis >/ 50%.

Main outcome measures: Stroke ipsilateral to the stenosis, all strokes, and perioperative complications (stroke or death).

Results: In patients who underwent carotid endarterectomy (n=1215) there was a significant reduction in the odds of ipsilateral stroke plus perioperative stroke or death (odds ratio 0.62; 95% confidence interval 0.44 to 0.86), corresponding to a 2% absolute risk reduction over about 3.1 years. The prevalence of stroke in any location was also reduced (0.68; 0.51 to 0.9) in patients undergoing carotid endarterectomy. During the immediate postoperative period there was an increased prevalence of stroke or death among such patients (4.51; 2.36 to 8.64).

Conclusion: Carotid endarterectomy in patients with asymptomatic carotid stenosis unequivocally reduces the incidence of ipsilateral stroke, though the absolute benefit is relatively small. Given the modest benefit of surgery for unselected patients with asymptomatic carotid artery stenosis carotid endarterectomy cannot be routinely recommended for these patients pending reliable identification of high risk subgroups, and medical management is a sensible alternative for most patients.

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Figures

Figure 1
Figure 1
Meta-analysis of aggregated data: effect of carotid endarterectomy in patients with asymptomatic carotid stenosis (MACE: Mayo asymptomatic carotid endarterectomy trial; VA: Veterans Administration trial; ACAS: Asymptomatic carotid atherosclerosis study; L’AURC: Etude multicentique prospective randomisée comparant traitment médical et chirurgical des stenoses serrées atheromateuses asymptomatiques des carotides)
Figure 2
Figure 2
Meta-analysis of perioperative complications (stroke or death) in patients undergoing carotid endarterectomy for asymptomatic carotid stenosis (see figure 1 for abbreviations)
See this image and copyright information in PMC

Comment in

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