Asymptomatic carotid artery disease.

Mohr, J. P.

doi:10.1161/01.str.13.4.431

Cited by 60 publications

(10 citation statements)

References 28 publications

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“…3 - 4 Carotid endarterectomy is performed in increasing numbers of patients 3 although its efficacy has not been demonstrated convincingly for either asymptomatic or symptomatic disease. Since a requirement of any treatment is that benefits should outweigh risks, the stroke risk reduction after carotid endarterectomy must outweigh the combined hazards of angiography and surgery.…”

Section: Althoughmentioning

confidence: 99%

The case against surgery for asymptomatic carotid stenosis.

Chambers¹,

Norris²

1984

Stroke

153

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The Case Against Surgery for Asymptomatic Carotid Stenosis BRIAN R. CHAMBERS, M B B S , FRACP, AND JOHN W. NORRIS, M D , FRCP, FRCP (C)SUMMARY Asymptomatic cervical bruits with their implication of underlying carotid artery disease, carry an established but low risk of stroke. In spite of the rising numbers of patients subjected to carotid endarterectomy for this condition, there is little evidence that the benefits outweigh the risks. Outcome data from community studies and the current prospective Toronto study of patients with asymptomatic neck bruits indicate that the annual stroke rate is 1-2%, and the annual cardiac death rate is 2-4%. Published data of the results of carotid surgery suggest that surgical risks outweigh any possible benefits, unless a subgroup with spontaneous stroke risk of at least 5% can be identified.Stroke Vol 15, No 6, 1984

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Section: Althoughmentioning

confidence: 99%

The case against surgery for asymptomatic carotid stenosis.

Chambers¹,

Norris²

1984

Stroke

153

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“…The management of the asymptomatic carotid plaque is controversial with sound arguments on both sides of the issue. 13 ' 25 However, in some institutions, the major indication for surgery is a carotid plaque, with or without neurological complaints, while in others the primary indication remains focal neurological symptoms. This introduces a major bias in the comparison of various reports.…”

mentioning

confidence: 99%

The ischemic tolerance of neural tissue and the need for monitoring and selective shunting during carotid endarterectomy.

Sundt¹

1983

Stroke

134

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“…The data suggest prophylactic carotid surgery may be detrimental if performed outside centers with proven low morbidity. 6 The training background of the surgeon related strongly to clinical indication for surgery. Those considering themselves vascular surgeons more frequently operated in the setting of asymptomatic carotid stenosis (p < 0.00001).…”

Section: Resultsmentioning

confidence: 99%

The practice of carotid endarterectomy in a large metropolitan area.

Brott¹,

Thalinger

1984

Stroke

188

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All carotid endarterectomies performed in the greater Cincinnati metropolitan area during 1980 were reviewed. For the 431 procedures performed in 16 hospitals, the operative stroke rate was 8.6% (37 of 431), and the operative mortality rate was 2.8% (12 of 431). The combined morbidity and mortality was 9.5% (41 of 431). Fifty percent of the procedures were done for asymptomatic carotid disease (216 of 431) and 50% were done for symptomatic carotid disease (215 of 431). The stroke rate was 5.6% for the asymptomatic patients and 11.6% for the symptomatic patients (difference significant, p less than 0.05). Neurosurgeons and vascular surgeons had similar surgical morbidity. All of the operative strokes involved the hemisphere ipsilateral to the endarterectomy. Fifty-seven percent of the operative strokes (21 of 37) occurred after a neurologically intact interval lasting hours to days. Four occurred following combined endarterectomy-coronary bypass surgery, and one was an intracerebral hemorrhage. The other late strokes (17) occurred without evidence for cardiac embolus or hemorrhage, consistent with a thrombogenic-embologenic operative site, and raising the question of need for adjunctive perioperative medical therapy.

show abstract

Asymptomatic carotid artery disease.

Cited by 60 publications

References 28 publications

The case against surgery for asymptomatic carotid stenosis.

The case against surgery for asymptomatic carotid stenosis.

The ischemic tolerance of neural tissue and the need for monitoring and selective shunting during carotid endarterectomy.

The practice of carotid endarterectomy in a large metropolitan area.

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