Benefit of Carotid Endarterectomy in Patients with Symptomatic Moderate or Severe Stenosis

作者：Henry J.M. Barnett, D. Wayne Taylor, Michael Eliasziw, Allan J. Fox, Gary G. Ferguson, Robert Brian Haynes, Richard N. Rankin, George Patrick Clagett, Vladimir Hachinski, David L. Sackett, Kevin E. Thorpe, Heather E. Meldrum, J. David Spence · 发表于：New England Journal of Medicine · 年份：1998 · DOI：10.1056/nejm199811123392002 · 被引用次数：3624 · 研究领域：Cerebrovascular and Carotid Artery Diseases、Oropharyngeal Anatomy and Pathologies、Renal and Vascular Pathologies

BACKGROUND: Previous studies have shown that carotid endarterectomy in patients with symptomatic severe carotid stenosis (defined as stenosis of 70 to 99 percent of the luminal diameter) is beneficial up to two years after the procedure. In this clinical trial, we assessed the benefit of carotid endarterectomy in patients with symptomatic moderate stenosis, defined as stenosis of less than 70 percent. We also studied the durability of the benefit of endarterectomy in patients with severe stenosis over eight years of follow-up. METHODS: Patients who had moderate carotid stenosis and transient ischemic attacks or nondisabling strokes on the same side as the stenosis (ipsilateral) within 180 days before study entry were stratified according to the degree of stenosis (50 to 69 percent or <50 percent) and randomly assigned either to undergo carotid endarterectomy (1108 patients) or to receive medical care alone (1118 patients). The average follow-up was five years, and complete data on outcome events were available for 99.7 percent of the patients. The primary outcome event was any fatal or nonfatal stroke ipsilateral to the stenosis for which the patient underwent randomization. RESULTS: Among patients with stenosis of 50 to 69 percent, the five-year rate of any ipsilateral stroke (failure rate) was 15.7 percent among patients treated surgically and 22.2 percent among those treated medically (P=0.045); to prevent one ipsilateral stroke during the five-year period, 15 patients wou...