50 Questions and Answers
from
Neurology
,
,Q
A 74-year-old patient is hospitalized with a right middle cerebral artery stroke. During the
work-up, the carotid duplex reveals a stenosis of 55% in the ipsilateral carotid artery.
Is carotid endarterectomy (CE) indicated for this patient?
A. Yes
B. No
1
, A
A. Yes.
The North American Symptomatic Carotid Endarterectomy Trial (NASCET) showed a significant
benefit of CE for patients with >/= 70% symptomatic stenosis. Two-year ipsilateral stroke risk
was 26% in the patients treated with medication and 9% in the CE group (P < .001).
A combined analysis of trials of symptomatic patients showed a benefit of CE for 50% to 69%
stenosis (adjusted relative risk [ARR], 4.6% over 5 years) and for >/= 70% (ARR, 16% over 5
years). The overall rate of stroke or death for all surgical patients within 30 days of trial surgery
was 7.1%.
Barclay L. AAN updates guidelines on carotid endarterectomy. Medscape Medical News. September 26, 2005.
Available at: http://www.medscape.com/viewarticle/513426. Accessed February 5, 2008.
2
from
Neurology
,
,Q
A 74-year-old patient is hospitalized with a right middle cerebral artery stroke. During the
work-up, the carotid duplex reveals a stenosis of 55% in the ipsilateral carotid artery.
Is carotid endarterectomy (CE) indicated for this patient?
A. Yes
B. No
1
, A
A. Yes.
The North American Symptomatic Carotid Endarterectomy Trial (NASCET) showed a significant
benefit of CE for patients with >/= 70% symptomatic stenosis. Two-year ipsilateral stroke risk
was 26% in the patients treated with medication and 9% in the CE group (P < .001).
A combined analysis of trials of symptomatic patients showed a benefit of CE for 50% to 69%
stenosis (adjusted relative risk [ARR], 4.6% over 5 years) and for >/= 70% (ARR, 16% over 5
years). The overall rate of stroke or death for all surgical patients within 30 days of trial surgery
was 7.1%.
Barclay L. AAN updates guidelines on carotid endarterectomy. Medscape Medical News. September 26, 2005.
Available at: http://www.medscape.com/viewarticle/513426. Accessed February 5, 2008.
2
