Document Detail


Surgical versus nonoperative treatment of asymptomatic carotid stenosis. 290 patients documented by intravenous angiography.
MedLine Citation:
PMID:  3527089     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
From 1980 through 1982, intravenous extracranial digital subtraction angiography (DSA) was performed in 6684 patients at the Cleveland Clinic. Of these, 290 previously unoperated patients had asymptomatic carotid stenosis exceeding 50% of lumen diameter on unequivocal DSA studies. Either the presence or the absence of carotid bruits substantially misrepresented the severity of angiographic stenosis on approximately 30% of sides. Nonoperative management was employed in 195 patients, including 104 (53%) who received antiplatelet therapy, while another group of 95 patients underwent prophylactic carotid endarterectomy. During mean follow-up intervals of 33-38 months, surgical treatment significantly reduced the cumulative incidence of subsequent neurologic events in men (p = 0.05). Statistically unconfirmed trends also suggested that carotid endarterectomy tended to prevent late strokes in subsets of patients with greater than 70% stenosis or bilateral carotid lesions. The overall stroke rate for women was higher in the surgical group (p = 0.03), in part because of their unusual risk for perioperative complications (9%) in this particular series.
Authors:
N R Hertzer; R A Flanagan; E G Beven; P J O'Hara
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Annals of surgery     Volume:  204     ISSN:  0003-4932     ISO Abbreviation:  Ann. Surg.     Publication Date:  1986 Aug 
Date Detail:
Created Date:  1986-09-17     Completed Date:  1986-09-17     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  163-71     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Anticoagulants / therapeutic use
Auscultation
Blood Platelets / drug effects
Carotid Arteries / radiography,  surgery
Carotid Artery Diseases / complications,  radiography,  surgery*,  therapy
Cerebrovascular Disorders / epidemiology,  etiology
Constriction, Pathologic
Endarterectomy
Female
Humans
Ischemic Attack, Transient / epidemiology,  etiology
Male
Middle Aged
Postoperative Complications
Subtraction Technique
Chemical
Reg. No./Substance:
0/Anticoagulants
Comments/Corrections

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