Comparison of North American Symptomatic Carotid Endarterectomy Trial and population-based outcomes for carotid endarterectomy

Jr Hallett, Jr Pietropaoli, D. M. Ilstrup, M. M. Gayari, J. A. Williams, F. B. Meyer, D. Silver

Research output: Contribution to journalArticle

29 Scopus citations

Abstract

Purpose: The North American Symptomatic Carotid Endarterectomy Trial (NASCET) advocated the use of carotid endarterectomy (CEA) for transient ischemic attacks (TIAs), nondisabling strokes, and ipsilateral high-grade stenosis in highly selected patients. Whether similar results are achieved when CEA is applied to an entire geographically defined population is unknown but important if the NASCET recommendations are to be applied broadly to all community patients. Methods: To determine the survival rate to ipsilateral stroke after CEA for all symptomatic patients in a defined population, we reviewed the medical records of all patients residing in Olmsted County, Minn. (approximately 100,000), who underwent a CEA for TIA or nondisabling stroke between 1970 and 1995. Their outcomes were compared with the NASCET results. Results: In the community of Olmsted County, 297 patients (108 women and 189 men) underwent 322 CEAs during the study period. TIAs or nondisabling stroke was the indication in 254 patients (86%), whereas the remaining 14% had asymptomatic stenosis. After CEA for symptomatic lesions, survival rate free of ipsilateral Stroke was 97% at 2 years, 93% at 5 years, and 92% at 10 years. These results are similar to the NASCET survival rates free of ipsilateral stroke at 2 years (91%). However, the 30-day postoperative stroke rate for patients older than 80 years was significantly higher than that for patients younger than 80 years. Conclusions: When the NASCET results are compared with a population-based experience in which all symptomatic patients undergoing CEA were analyzed, the early outcomes were similar. Our population-based data also document the remarkably durable long-term results of CEA in preventing stroke and present another benchmark for carotid stent angioplasty.

Original languageEnglish (US)
Pages (from-to)845-851
Number of pages7
JournalJournal of vascular surgery
Volume27
Issue number5
DOIs
StatePublished - 1998

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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    Hallett, J., Pietropaoli, J., Ilstrup, D. M., Gayari, M. M., Williams, J. A., Meyer, F. B., & Silver, D. (1998). Comparison of North American Symptomatic Carotid Endarterectomy Trial and population-based outcomes for carotid endarterectomy. Journal of vascular surgery, 27(5), 845-851. https://doi.org/10.1016/s0741-5214(98)70264-2