Stroke: carotid endarterectomy decreases death in high-grade stenosis.

Clinical bottom line (level 1a)

  1. Patients with between 50% and 99% symptomatic carotid stenosis who are given carotid endarterectomy are less likely to have a disabling stroke or death, than those given no surgery.
  2. Patients with between 50 and 79% stenosis who are given carotid endarterectomy are less likely to have a disabling stroke or death, than those given no surgery.
  3. Patients with less than 70% stenosis who are given carotid endarterectomy may be more likely to have a disabling stroke or death.
Cina et al: The Cochrane Library, Issue 2, Oxford: Update Software 1999; 2: -
Expires December 2002

The study

Systematic review of unconfounded truly randomised trials of
  • Patients: symptomatic carotid stenosis and recent transient ischaemic attacks or minor ischaemic strokes in the territory of the artery
  • Intervention: carotid endarterectomy compared with no carotid surgery
  • Outcome: death or major disability after stroke


    • Articles found in ?language using Cochrane Stroke Group trials register, MEDLINE, EMBASE, Healthstar and Serline, Cochrane Library, Database of Abstracts of Reviews of Effectiveness and Best Evidence, from 1966 to March 1999 (search terms: ? ) and searched reference lists of all articles and of review articles.

    Selection criteria: as above
    Appraisal criteria: detailed in text
    Articles excluded if:

    Three randomised controlled trials were included.

    The evidence

    Outcome Time to outcome CER OR
    (95% CI)    		 NNT
    (95% CI)
    any disabling stroke or death with 70-99% stenosis or 50-99% stenosis unknown /
    (%)    		 0.48
    (0.33 to 0.70)     		15
    (10 to 31)
    disabling stroke or death with 50-69% stenosis or 70-79% stenosis unknown /
    (%)    		 0.69
    (0.51 to 0.94)     		21
    (11 to 125)
    disabling stroke or death with <50% stenosis or <70% stenosis unknown /
    (%)    		 1.23
    (1.00 to 1.51)     		45
    (22 to infinity)

    Comments

    1. The trials involved measured odds of disabling stroke or death in patients with slightly different degrees of stenosis, so two percentages of stenosis have been entered in the results.

    Citation

    1. Cina CS, Clase CM, Haynes RB: Carotid endarterectomy for symptomatic carotid stenosis. The Cochrane Library, Issue 2, Oxford: Update Software 1999; 2: -
    Contributor: Clare Wotton and Musab Hayatli, December 1999
    Reviewer: Martin Mueller

    Clinical Question.
    Patient symptomatic carotid stenosis
    Intervention or Exposure carotid endarterectomy
    Comparison no carotid surgery
    Outcome death or disabling stroke