Document Detail


The dilemma of surgical treatment for patients with asymptomatic carotid disease.
MedLine Citation:
PMID:  7574229     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Several case series have suggested that endarterectomy is beneficial in asymptomatic carotid artery disease. Four randomized trials have been done in this area, the most recent of which is the Asymptomatic Carotid Atherosclerosis Study (ACAS). Results of the first three trials were negative, and ACAS produced a tantalizing, statistically significant finding that does not translate into clinical importance. Disabling strokes have not been reduced by surgical therapy, and the benefit for women has not been shown. It is unclear from this study whether persons with the greatest stenosis and the highest vascular risk profiles are appropriate candidates for endarterectomy. In patients in whom carotid artery disease is incidentally discovered, the benefits of the prophylactic addition of carotid endarterectomy to coronary bypass grafting or other major surgical procedure in patients are still unknown. Excellent surgical skill is of paramount importance for the future use of this procedure. Mass population screening to detect asymptomatic carotid disease will only be justified when and if future studies identify patients in whom the risk for disabling stroke after the procedure is clearly reduced.
Authors:
H J Barnett; H E Meldrum; M Eliasziw
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Publication Detail:
Type:  Comment; Journal Article; Review    
Journal Detail:
Title:  Annals of internal medicine     Volume:  123     ISSN:  0003-4819     ISO Abbreviation:  Ann. Intern. Med.     Publication Date:  1995 Nov 
Date Detail:
Created Date:  1995-11-07     Completed Date:  1995-11-07     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  0372351     Medline TA:  Ann Intern Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  723-5     Citation Subset:  AIM; IM    
Affiliation:
John P. Robarts Research Institute, London, Ontario, Canada.
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MeSH Terms
Descriptor/Qualifier:
Carotid Stenosis / surgery*
Cerebrovascular Disorders / prevention & control*
Endarterectomy, Carotid*
Female
Humans
Comments/Corrections
Comment On:
Ann Intern Med. 1995 Nov 1;123(9):649-55   [PMID:  7574219 ]
Ann Intern Med. 1995 Nov 1;123(9):729   [PMID:  7574232 ]
Comment In:
Ann Intern Med. 1996 Sep 15;125(6):516-7   [PMID:  8779474 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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