Should the Multicenter Carotid Endarterectomy Trials Be Repeated?
Seemant Chaturvedi, MD
Arch Neurol. 2003;60:774-775.
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THE 2 MAJOR clinical trials pertaining to carotid endarterectomy (CE) that were conducted in North America and published in the past decade were landmark clinical achievements. These studies, the North American Symptomatic Carotid Endarterectomy Trial (NASCET)1-2 and the Asymptomatic Carotid Atherosclerosis Study (ACAS),3 brought hard data to a surgical procedure that had been performed for decades but without clear efficacy. The NASCET study found that patients with recently symptomatic 70% to 99% angiographic stenosis had robust benefit from CE, with a 17% absolute difference at 2 years in terms of recurrent ipsilateral stroke compared with medical management.
The NASCET "high-moderate" group (50%-69% stenosis) and the ACAS cohort (60%-99% stenosis) had marginal benefits with surgery compared with medical treatment. The annual absolute difference was 1.3% in the NASCET high-moderate group and only 1.2% in the ACAS group. Many clinicians have found these differences not to be clinically meaningful.
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From the Department of Neurology, Wayne State University, Detroit, Mich.
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