Carotid endarterectomy for symptomatic carotid stenosis

Cina CS, Clase CM, Haynes RB.

Summary

Surgical removal of the thickened diseased inside lining (endarterectomy) causing narrowing (stenosis) of the carotid artery to reduce the risk of stroke in people already showing symptoms

Strokes cause long-term disability and death. The chances of dying are much higher with subsequent strokes, which often occur within one year of the first. Strokes are often associated with blockages and severe narrowing in the internal carotid and other large blood vessels carrying oxygenated blood from the heart to the brain. Surgical removal of the
fatty deposits and blood clots from inside the carotid artery wall may reduce the risk of stroke but carries a risk of peri-operative complications including disabling stroke and death. This review identified three controlled multicentre trials; 6143 patients who were elderly, predominantly male, and had a recent non-disabling stroke or transient ischaemic attack with confirmed narrowing of the carotid artery. Many had heart disease, diabetes and high blood pressure. Increased degree of narrowing, advanced age and male sex were associated with increasing benefit from surgery. Patients with lesser degrees of narrowing were harmed. From two trials, which included 5950 patients, the number of patients with severe narrowing needed to be operated on to prevent one disabling stroke or death over 2 to 6 years follow up was 15 (number needed to treat or NNT), increased to 21 with less severe stenosis.