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Related Experiment Videos

Update on carotid endarterectomy

H J Barnett1, H E Meldrum

  • 1John P. Robarts Research Institute, London, Ontario, Canada.

Current Opinion in Cardiology
|September 1, 1995
PubMed
Summary
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Carotid artery surgery (endarterectomy) is best for symptomatic patients with severe (70%+) blockages. Guidelines for other patients, including those without symptoms, are still unclear.

Area of Science:

  • Vascular Surgery
  • Neurology
  • Clinical Trials

Background:

  • Carotid artery disease management relies on randomized clinical trials.
  • Therapeutic decisions for carotid stenosis require careful consideration of patient symptoms and stenosis severity.

Purpose of the Study:

  • To review current evidence from major trials on carotid endarterectomy.
  • To clarify treatment guidelines for symptomatic and asymptomatic patients with carotid artery disease.

Main Methods:

  • Analysis of data from major randomized clinical trials on carotid endarterectomy.
  • Evaluation of stroke risk and operative risk in different patient groups.

Main Results:

  • Endarterectomy is the standard treatment for symptomatic patients with 70% or greater stenosis.

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  • Treatment for symptomatic patients with less than 70% stenosis is under investigation.
  • Asymptomatic patients with 80-90% stenosis have a stroke risk comparable to surgical risk.

    • Conclusions:

    • Clear guidelines for endarterectomy are lacking, especially for asymptomatic patients.
    • Treatment decisions should integrate stenosis degree and individual patient vascular risk profiles.