Long-term clinical and angiographic outcomes in symptomatic patients with 70% to 99% carotid artery stenosis

M. Paciaroni, M. Eliasziw, B. L. Sharpe, L. J. Kapelle, Seemant Chaturvedi, H. Meldrum, H. J M Barnett

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Background and Purpose - In 1991, the North American Symptomatic Carotid Endarterectomy Trial (NASCET) reported the benefit of carotid endarterectomy for 659 patients with 70% to 99% stenosis. Follow-up continued until 1997. Methods - The present study examined the risks and causes of ipsilateral stroke in the randomized groups and in those who had delayed endarterectomy or continued on medical therapy and also examined the evolution of carotid disease on follow-up imaging. Results - By on-treatment (efficacy) analysis, the risk of any ipsilateral stroke at 3 years was 28.3% for medically randomized and 8.9% for surgically randomized patients (19.4% absolute risk reduction, P<0.001). For combined disabling or fatal ipsilateral stroke, the risks were 14.0% and 3.4%, respectively (10.6% absolute risk reduction). In medical patient, >80% of the first strokes at 3 years were of large-artery origin. After February 1991, 116 suitable medical patients underwent endarterectomy within 6 months, and 115 continued on medical therapy. The 3-year risk of any ipsilateral stroke in the groups of 116 and 115 patients was 7.9% and 15.0%, respectively (7.1% absolute risk reduction). During follow-up, 81 patients had angiograms comparable to the baseline images. Progression by ≥10% occured in 7 patient; regression, in 8; no change, in 39; and occlusion, in 27. By use of both angiography and ultrasound, 63 (25.5%) of the 247 medically treated patients progressed to occlusion, of whom 31.7% had an ipsilateral stroke before or on the day of occlusion. Conclusions - Endarterectomy for patients with 70% to 99% stenosis and recent symptoms was efficacious in the long term. Compared with patients who continued on medical therapy, medical patients with delayed endarterectomy experienced a moderate benefit. Medically treated patients experience a high risk of occlusion.

Original languageEnglish (US)
Pages (from-to)2037-2042
Number of pages6
JournalStroke
Volume31
Issue number9
StatePublished - 2000
Externally publishedYes

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Carotid Stenosis
Endarterectomy
Stroke
Numbers Needed To Treat
Carotid Endarterectomy
Angiography
Pathologic Constriction
Therapeutics
Arteries

Keywords

  • Carotid stenosis
  • Cerebral ischemia
  • Endarterectomy
  • Occlusion

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

Cite this

Paciaroni, M., Eliasziw, M., Sharpe, B. L., Kapelle, L. J., Chaturvedi, S., Meldrum, H., & Barnett, H. J. M. (2000). Long-term clinical and angiographic outcomes in symptomatic patients with 70% to 99% carotid artery stenosis. Stroke, 31(9), 2037-2042.

Long-term clinical and angiographic outcomes in symptomatic patients with 70% to 99% carotid artery stenosis. / Paciaroni, M.; Eliasziw, M.; Sharpe, B. L.; Kapelle, L. J.; Chaturvedi, Seemant; Meldrum, H.; Barnett, H. J M.

In: Stroke, Vol. 31, No. 9, 2000, p. 2037-2042.

Research output: Contribution to journalArticle

Paciaroni, M, Eliasziw, M, Sharpe, BL, Kapelle, LJ, Chaturvedi, S, Meldrum, H & Barnett, HJM 2000, 'Long-term clinical and angiographic outcomes in symptomatic patients with 70% to 99% carotid artery stenosis', Stroke, vol. 31, no. 9, pp. 2037-2042.
Paciaroni M, Eliasziw M, Sharpe BL, Kapelle LJ, Chaturvedi S, Meldrum H et al. Long-term clinical and angiographic outcomes in symptomatic patients with 70% to 99% carotid artery stenosis. Stroke. 2000;31(9):2037-2042.
Paciaroni, M. ; Eliasziw, M. ; Sharpe, B. L. ; Kapelle, L. J. ; Chaturvedi, Seemant ; Meldrum, H. ; Barnett, H. J M. / Long-term clinical and angiographic outcomes in symptomatic patients with 70% to 99% carotid artery stenosis. In: Stroke. 2000 ; Vol. 31, No. 9. pp. 2037-2042.
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abstract = "Background and Purpose - In 1991, the North American Symptomatic Carotid Endarterectomy Trial (NASCET) reported the benefit of carotid endarterectomy for 659 patients with 70{\%} to 99{\%} stenosis. Follow-up continued until 1997. Methods - The present study examined the risks and causes of ipsilateral stroke in the randomized groups and in those who had delayed endarterectomy or continued on medical therapy and also examined the evolution of carotid disease on follow-up imaging. Results - By on-treatment (efficacy) analysis, the risk of any ipsilateral stroke at 3 years was 28.3{\%} for medically randomized and 8.9{\%} for surgically randomized patients (19.4{\%} absolute risk reduction, P<0.001). For combined disabling or fatal ipsilateral stroke, the risks were 14.0{\%} and 3.4{\%}, respectively (10.6{\%} absolute risk reduction). In medical patient, >80{\%} of the first strokes at 3 years were of large-artery origin. After February 1991, 116 suitable medical patients underwent endarterectomy within 6 months, and 115 continued on medical therapy. The 3-year risk of any ipsilateral stroke in the groups of 116 and 115 patients was 7.9{\%} and 15.0{\%}, respectively (7.1{\%} absolute risk reduction). During follow-up, 81 patients had angiograms comparable to the baseline images. Progression by ≥10{\%} occured in 7 patient; regression, in 8; no change, in 39; and occlusion, in 27. By use of both angiography and ultrasound, 63 (25.5{\%}) of the 247 medically treated patients progressed to occlusion, of whom 31.7{\%} had an ipsilateral stroke before or on the day of occlusion. Conclusions - Endarterectomy for patients with 70{\%} to 99{\%} stenosis and recent symptoms was efficacious in the long term. Compared with patients who continued on medical therapy, medical patients with delayed endarterectomy experienced a moderate benefit. Medically treated patients experience a high risk of occlusion.",
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AU - Eliasziw, M.

AU - Sharpe, B. L.

AU - Kapelle, L. J.

AU - Chaturvedi, Seemant

AU - Meldrum, H.

AU - Barnett, H. J M

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AB - Background and Purpose - In 1991, the North American Symptomatic Carotid Endarterectomy Trial (NASCET) reported the benefit of carotid endarterectomy for 659 patients with 70% to 99% stenosis. Follow-up continued until 1997. Methods - The present study examined the risks and causes of ipsilateral stroke in the randomized groups and in those who had delayed endarterectomy or continued on medical therapy and also examined the evolution of carotid disease on follow-up imaging. Results - By on-treatment (efficacy) analysis, the risk of any ipsilateral stroke at 3 years was 28.3% for medically randomized and 8.9% for surgically randomized patients (19.4% absolute risk reduction, P<0.001). For combined disabling or fatal ipsilateral stroke, the risks were 14.0% and 3.4%, respectively (10.6% absolute risk reduction). In medical patient, >80% of the first strokes at 3 years were of large-artery origin. After February 1991, 116 suitable medical patients underwent endarterectomy within 6 months, and 115 continued on medical therapy. The 3-year risk of any ipsilateral stroke in the groups of 116 and 115 patients was 7.9% and 15.0%, respectively (7.1% absolute risk reduction). During follow-up, 81 patients had angiograms comparable to the baseline images. Progression by ≥10% occured in 7 patient; regression, in 8; no change, in 39; and occlusion, in 27. By use of both angiography and ultrasound, 63 (25.5%) of the 247 medically treated patients progressed to occlusion, of whom 31.7% had an ipsilateral stroke before or on the day of occlusion. Conclusions - Endarterectomy for patients with 70% to 99% stenosis and recent symptoms was efficacious in the long term. Compared with patients who continued on medical therapy, medical patients with delayed endarterectomy experienced a moderate benefit. Medically treated patients experience a high risk of occlusion.

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KW - Cerebral ischemia

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KW - Occlusion

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