September 27th, 2010
Carotid Endarterectomy Still Beneficial At 10 Years
Carotid endarterectomy (CEA) in asymptomatic patients under 75 years of age reduces the long-term risk of stroke, according to 10-year results from the Asymptomatic Carotid Surgery Trial (ACST), published in the Lancet. The ACST investigators randomized 3120 asymptomatic patients to immediate CEA or to indefinite deferral of CEA. At 5 years, CEA had been performed on 92.1% of patients in the immediate CEA group compared to 16.5% in the deferral group. At 10 years, the net risk (death or stroke within 30 days and non-perioperative stroke) was 13.4% % in the immediate CEA group versus 17.9% in the deferral group. The relative reduction in risk was independent of whether the patients were taking lipid-lowering therapy, but the absolute risk of stroke was lower in patients on lipid-lowering therapy.
The authors concluded that CEA is most effective in patients with a long life expectancy, “because the potential long-term benefits of CEA are sharply curtailed in those who have less than 10 years of life expectancy… For otherwise healthy men and women younger than 75 years… the results from this trial suggest net benefit from CEA, as long as perioperative risks remain low.”