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Carotid endarterectomy itself can cause strokes, so to be of benefit in preventing strokes over time, the risks for combined 30-day mortality and stroke risk following surgery should be < 3% for asymptomatic people and ≤ 6% for symptomatic people. [1] The carotid artery is the large vertical artery in red.
The surgical mortality of endarterectomy ranges from 1–2% to as much as 10%. Two large randomized clinical trials have demonstrated that carotid surgery done with a 30-day stroke and death risk of 3% or less will benefit asymptomatic people with ≥60% stenosis who are expected to live at least 5 years after surgery.
European centres were finding similar results, [13] and thus Dr. Barnett spearheaded the establishment of carotid artery surgery for preventing stroke. The question remained if carotid endarterectomy was beneficial in patients with lower degrees of carotid stenosis, i.e. less than 70%. To answer that question, Barnett and colleagues randomly ...
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Coronary endarterectomy involves removing atheroma from the wall of blocked blood vessels (coronary) supplying the heart muscle. The concept was first introduced by Bailey [2] in the 1950s prior to the advent of coronary artery bypass surgery to help patients with angina and coronary artery disease. It is still used today when coronary artery ...
North American Symptomatic Carotid Endarterectomy Trial (NASCET) 1415: Showed carotid endarterectomy was beneficial in symptomatic patients. Two year stroke rate in patients with > 70% carotid stenosis decreased from 26% to 9%. Two year stroke rate in patients with > 50% decreased from 15% to 9%. [42] [43] Asymptomatic Carotid Atherosclerosis ...
Carotid artery stenting is an endovascular procedure where a stent is deployed within the lumen of the carotid artery to treat narrowing of the carotid artery and decrease the risk of stroke. It is used to treat narrowing of the carotid artery in high-risk patients, when carotid endarterectomy is considered too risky.
This ambitious multicenter trial is designed to address critical questions regarding the management of asymptomatic carotid artery disease. [24] CREST-2 is testing whether medical management alone or medical management combined with carotid stenting or surgery is the superior treatment strategy for preventing strokes in these patients.