Effect of contralateral occlusion on long-term efficacy of endarterectomy in the Asymptomatic Carotid Atherosclerosis Study (ACAS)
Background and Purpose —The Asymptomatic Carotid Atherosclerosis Study (ACAS) established the effectiveness of prophylactic carotid endarterectomy, for patients in good health who had stenosis ≥60%, if conducted by surgeons with a surgical morbidity and mortality of
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| Veröffentlicht in: | Stroke (1970) 2000-10, Vol.31 (10), p.2330-2334 |
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| container_issue | 10 |
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| container_title | Stroke (1970) |
| container_volume | 31 |
| creator | BAKER, William H HOWARD, Virginia J HOWARD, George TOOLE, James F |
| description | Background and Purpose
—The Asymptomatic Carotid Atherosclerosis Study (ACAS) established the effectiveness of prophylactic carotid endarterectomy, for patients in good health who had stenosis ≥60%, if conducted by surgeons with a surgical morbidity and mortality of |
| doi_str_mv | 10.1161/01.str.31.10.2330 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_197735189</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>62601051</sourcerecordid><originalsourceid>FETCH-LOGICAL-c445t-586e607058471a27b9abb3ac6754f8c27ec7dd43679776e6b490b455aeb298373</originalsourceid><addsrcrecordid>eNpFkE9LwzAYh4MoOKcfwFsQD3poTZqkaY9lzD8wENw8lzRNNKNtZpIeevWTm7KBEN7Ak9_zvuEF4BajFOMcPyGc-uBSgtNIMkLQGVhgltGE5llxDhYIkTLJaFlegivv9wihjBRsAX7XWisZoNVQ2iE40YmgYoVWym70xg4wns4OX0nkPVRaGynkNAtqaIWLNPq2n6AZYPhWsPJTf4hABCPhSjgbTAur-OKsl91cjYfbMLYTfKhW1fbxGlxo0Xl1c7qX4PN5vVu9Jpv3l7dVtUkkpSwkrMhVjjhiBeVYZLwpRdMQIXPOqC5kxpXkbUtJzkvOY7ShJWooY0I1WVkQTpbg7tj34OzPqHyo93Z0QxxZ46gQhosyhvAxJONHvVO6PjjTCzfVGNXzpmuE6-3uoyZ4JvOmo3N_aiy8FJ12YpDG_4sMM0Y5-QO4gX9z</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>197735189</pqid></control><display><type>article</type><title>Effect of contralateral occlusion on long-term efficacy of endarterectomy in the Asymptomatic Carotid Atherosclerosis Study (ACAS)</title><source>American Heart Association Journals</source><source>Journals@Ovid Complete</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>BAKER, William H ; HOWARD, Virginia J ; HOWARD, George ; TOOLE, James F</creator><creatorcontrib>BAKER, William H ; HOWARD, Virginia J ; HOWARD, George ; TOOLE, James F</creatorcontrib><description>Background and Purpose
—The Asymptomatic Carotid Atherosclerosis Study (ACAS) established the effectiveness of prophylactic carotid endarterectomy, for patients in good health who had stenosis ≥60%, if conducted by surgeons with a surgical morbidity and mortality of <3%. This secondary analysis was performed to determine whether the presence of contralateral cervical carotid occlusion alters the efficacy of asymptomatic ipsilateral carotid endarterectomy.
Methods
—One hundred sixty-three participants who had a baseline contralateral occlusion documented by Doppler ultrasound (77 medical, 86 surgical) were compared with 1485 participants with a patent contralateral carotid artery (748 medical, 737 surgical) for the risk of a combined end point of perioperative (30-day) death or stroke or long-term (5-year) ipsilateral stroke.
Results
—For those without contralateral occlusion, surgery was associated with a 6.7% absolute reduction in the 5-year risk (95% CI, 2.1% to 11.4%), while for those with a contralateral occlusion, surgery was associated with a 2.0% absolute increase in risk (95% CI, −9.3% to 5.2%), which was a statistically significant difference in the effect of surgery (
P
=0.047). This difference is primarily attributable to low long-term risk for medically managed patients with contralateral occlusion.
Conclusions
—While this post hoc analysis should be interpreted with caution, the findings suggest that endarterectomy in asymptomatic subjects with contralateral occlusion provides no long-term benefit (and may be harmful) in preventing stroke and death. These findings were a result of the benign course of medically treated subjects.</description><identifier>ISSN: 0039-2499</identifier><identifier>EISSN: 1524-4628</identifier><identifier>DOI: 10.1161/01.str.31.10.2330</identifier><identifier>CODEN: SJCCA7</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Biological and medical sciences ; Medical sciences ; Neurology ; Vascular diseases and vascular malformations of the nervous system</subject><ispartof>Stroke (1970), 2000-10, Vol.31 (10), p.2330-2334</ispartof><rights>2000 INIST-CNRS</rights><rights>Copyright American Heart Association, Inc. Oct 2000</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c445t-586e607058471a27b9abb3ac6754f8c27ec7dd43679776e6b490b455aeb298373</citedby><cites>FETCH-LOGICAL-c445t-586e607058471a27b9abb3ac6754f8c27ec7dd43679776e6b490b455aeb298373</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,3687,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1515547$$DView record in Pascal Francis$$Hfree_for_read</backlink></links><search><creatorcontrib>BAKER, William H</creatorcontrib><creatorcontrib>HOWARD, Virginia J</creatorcontrib><creatorcontrib>HOWARD, George</creatorcontrib><creatorcontrib>TOOLE, James F</creatorcontrib><title>Effect of contralateral occlusion on long-term efficacy of endarterectomy in the Asymptomatic Carotid Atherosclerosis Study (ACAS)</title><title>Stroke (1970)</title><description>Background and Purpose
—The Asymptomatic Carotid Atherosclerosis Study (ACAS) established the effectiveness of prophylactic carotid endarterectomy, for patients in good health who had stenosis ≥60%, if conducted by surgeons with a surgical morbidity and mortality of <3%. This secondary analysis was performed to determine whether the presence of contralateral cervical carotid occlusion alters the efficacy of asymptomatic ipsilateral carotid endarterectomy.
Methods
—One hundred sixty-three participants who had a baseline contralateral occlusion documented by Doppler ultrasound (77 medical, 86 surgical) were compared with 1485 participants with a patent contralateral carotid artery (748 medical, 737 surgical) for the risk of a combined end point of perioperative (30-day) death or stroke or long-term (5-year) ipsilateral stroke.
Results
—For those without contralateral occlusion, surgery was associated with a 6.7% absolute reduction in the 5-year risk (95% CI, 2.1% to 11.4%), while for those with a contralateral occlusion, surgery was associated with a 2.0% absolute increase in risk (95% CI, −9.3% to 5.2%), which was a statistically significant difference in the effect of surgery (
P
=0.047). This difference is primarily attributable to low long-term risk for medically managed patients with contralateral occlusion.
Conclusions
—While this post hoc analysis should be interpreted with caution, the findings suggest that endarterectomy in asymptomatic subjects with contralateral occlusion provides no long-term benefit (and may be harmful) in preventing stroke and death. These findings were a result of the benign course of medically treated subjects.</description><subject>Biological and medical sciences</subject><subject>Medical sciences</subject><subject>Neurology</subject><subject>Vascular diseases and vascular malformations of the nervous system</subject><issn>0039-2499</issn><issn>1524-4628</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2000</creationdate><recordtype>article</recordtype><recordid>eNpFkE9LwzAYh4MoOKcfwFsQD3poTZqkaY9lzD8wENw8lzRNNKNtZpIeevWTm7KBEN7Ak9_zvuEF4BajFOMcPyGc-uBSgtNIMkLQGVhgltGE5llxDhYIkTLJaFlegivv9wihjBRsAX7XWisZoNVQ2iE40YmgYoVWym70xg4wns4OX0nkPVRaGynkNAtqaIWLNPq2n6AZYPhWsPJTf4hABCPhSjgbTAur-OKsl91cjYfbMLYTfKhW1fbxGlxo0Xl1c7qX4PN5vVu9Jpv3l7dVtUkkpSwkrMhVjjhiBeVYZLwpRdMQIXPOqC5kxpXkbUtJzkvOY7ShJWooY0I1WVkQTpbg7tj34OzPqHyo93Z0QxxZ46gQhosyhvAxJONHvVO6PjjTCzfVGNXzpmuE6-3uoyZ4JvOmo3N_aiy8FJ12YpDG_4sMM0Y5-QO4gX9z</recordid><startdate>20001001</startdate><enddate>20001001</enddate><creator>BAKER, William H</creator><creator>HOWARD, Virginia J</creator><creator>HOWARD, George</creator><creator>TOOLE, James F</creator><general>Lippincott Williams & Wilkins</general><general>American Heart Association, Inc</general><scope>IQODW</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope></search><sort><creationdate>20001001</creationdate><title>Effect of contralateral occlusion on long-term efficacy of endarterectomy in the Asymptomatic Carotid Atherosclerosis Study (ACAS)</title><author>BAKER, William H ; HOWARD, Virginia J ; HOWARD, George ; TOOLE, James F</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c445t-586e607058471a27b9abb3ac6754f8c27ec7dd43679776e6b490b455aeb298373</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2000</creationdate><topic>Biological and medical sciences</topic><topic>Medical sciences</topic><topic>Neurology</topic><topic>Vascular diseases and vascular malformations of the nervous system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>BAKER, William H</creatorcontrib><creatorcontrib>HOWARD, Virginia J</creatorcontrib><creatorcontrib>HOWARD, George</creatorcontrib><creatorcontrib>TOOLE, James F</creatorcontrib><collection>Pascal-Francis</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><jtitle>Stroke (1970)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>BAKER, William H</au><au>HOWARD, Virginia J</au><au>HOWARD, George</au><au>TOOLE, James F</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of contralateral occlusion on long-term efficacy of endarterectomy in the Asymptomatic Carotid Atherosclerosis Study (ACAS)</atitle><jtitle>Stroke (1970)</jtitle><date>2000-10-01</date><risdate>2000</risdate><volume>31</volume><issue>10</issue><spage>2330</spage><epage>2334</epage><pages>2330-2334</pages><issn>0039-2499</issn><eissn>1524-4628</eissn><coden>SJCCA7</coden><abstract>Background and Purpose
—The Asymptomatic Carotid Atherosclerosis Study (ACAS) established the effectiveness of prophylactic carotid endarterectomy, for patients in good health who had stenosis ≥60%, if conducted by surgeons with a surgical morbidity and mortality of <3%. This secondary analysis was performed to determine whether the presence of contralateral cervical carotid occlusion alters the efficacy of asymptomatic ipsilateral carotid endarterectomy.
Methods
—One hundred sixty-three participants who had a baseline contralateral occlusion documented by Doppler ultrasound (77 medical, 86 surgical) were compared with 1485 participants with a patent contralateral carotid artery (748 medical, 737 surgical) for the risk of a combined end point of perioperative (30-day) death or stroke or long-term (5-year) ipsilateral stroke.
Results
—For those without contralateral occlusion, surgery was associated with a 6.7% absolute reduction in the 5-year risk (95% CI, 2.1% to 11.4%), while for those with a contralateral occlusion, surgery was associated with a 2.0% absolute increase in risk (95% CI, −9.3% to 5.2%), which was a statistically significant difference in the effect of surgery (
P
=0.047). This difference is primarily attributable to low long-term risk for medically managed patients with contralateral occlusion.
Conclusions
—While this post hoc analysis should be interpreted with caution, the findings suggest that endarterectomy in asymptomatic subjects with contralateral occlusion provides no long-term benefit (and may be harmful) in preventing stroke and death. These findings were a result of the benign course of medically treated subjects.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><doi>10.1161/01.str.31.10.2330</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Stroke (1970), 2000-10, Vol.31 (10), p.2330-2334 |
| issn | 0039-2499 1524-4628 |
| language | eng |
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| source | American Heart Association Journals; Journals@Ovid Complete; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Biological and medical sciences Medical sciences Neurology Vascular diseases and vascular malformations of the nervous system |
| title | Effect of contralateral occlusion on long-term efficacy of endarterectomy in the Asymptomatic Carotid Atherosclerosis Study (ACAS) |
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