Related Experiment Videos
Surgery for asymptomatic carotid artery stenosis
Y P Panayiotopoulos1, S T Padayachee, P R Taylor
1Department of Surgery, Guy's Hospital, London.
The British Journal of Clinical Practice
|September 1, 1996
Summary
Carotid endarterectomy (CAE) benefits symptomatic patients with internal carotid artery (ICA) stenosis. However, its role in asymptomatic ICA stenosis remains controversial due to varying trial criteria and limitations.
Area of Science:
- Vascular Surgery
- Neurology
- Clinical Trials
Background:
- European Carotid Surgery Trial (ECST) and North American Symptomatic Carotid Endarterectomy Trial (NASCET) identified benefits of carotid artery endarterectomy (CAE) for symptomatic internal carotid artery (ICA) stenosis.
- These trials utilized differing criteria for defining greater than 70% ICA stenosis.
Purpose of the Study:
- To review the evidence for carotid endarterectomy (CAE) in patients with internal carotid artery (ICA) stenosis.
- To highlight the controversies surrounding CAE for asymptomatic ICA stenosis.
Main Methods:
- Review of major clinical trials including ECST, NASCET, Carotid Artery Stenosis with Asymptomatic Narrowing Operation Versus Aspirin (CASANOVA), Veterans Administration Asymptomatic Carotid Study (VAACS), and Asymptomatic Carotid Artery Stenosis (ACAS).
- Discussion of the limitations and varying methodologies of these trials.
Main Results:
- Symptomatic severe ICA stenosis (>70%) has a defined benefit from CAE.
- Trials investigating asymptomatic ICA stenosis (CASANOVA, VAACS, ACAS) have design limitations.
- The Asymptomatic Carotid Stenosis Trial (ACST) is ongoing.
Conclusions:
- The role of CAE in asymptomatic internal carotid artery (ICA) stenosis is not definitively established.
- Further understanding of the natural history of asymptomatic ICA disease is required.
- Surgical intervention for asymptomatic ICA stenosis remains a controversial topic pending further evidence.