An analysis of perioperative surgical mortality and morbidity in the asymptomatic carotid atherosclerosis study

被引:134
作者
Young, B
Moore, WS
Robertson, JT
Toole, JF
Ernst, CB
Cohen, SN
Broderick, JP
Dempsey, RJ
Hosking, JD
机构
[1] UNIV KENTUCKY, ALBERT B CHANDLER MED CTR, LEXINGTON, KY 40536 USA
[2] UNIV TENNESSEE, DEPT NEUROSURG, MEMPHIS, TN USA
[3] UNIV CALIF LOS ANGELES, DEPT SURG, LOS ANGELES, CA 90024 USA
[4] HENRY FORD HOSP, DEPT VASC SURG, DETROIT, MI 48202 USA
[5] UNIV N CAROLINA, CHAPEL HILL, NC USA
[6] UNIV CINCINNATI, COLL MED, CINCINNATI, OH 45221 USA
[7] W LOS ANGELES VET AFFAIRS MED CTR, NEUROL SERV, LOS ANGELES, CA USA
关键词
carotid endarterectomy; carotid stenosis; clinical trials; complications;
D O I
10.1161/01.STR.27.12.2216
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background and Purpose Our aim was to determine the perioperative morbidity and mortality rates of patients in the surgical arm of the multi-institutional, prospective, randomized Asymptomatic Carotid Atherosclerosis Study (ACAS). Methods Of 828 patients with carotid stenosis of 60% or more randomized to the surgical arm of ACAS, 721 underwent carotid endarterectomy (CEA). To qualify for participation, surgeons were required to have performed at least 12 CEAs per year with a combined neurological morbidity and mortality rate no greater than 3% for asymptomatic patients and 5% for symptomatic patients. Clinical centers had to demonstrate arteriographic morbidity less than 1% and mortality less than 0.1% per year. Primary events were stroke and death in the period between randomization and 30 days after surgery; secondary events were transient ischemic attack and myocardial infarction occurring in the same period. Results Of the 721 patients who underwent CEA, 1 died and 10 others had strokes within 30 days (1.5%). Of the 415 who underwent arteriography after randomization but before CEA, 5 (1.2%) suffered transient ischemic attack or stroke caused by arteriography. Thus, a nearly equal risk of stroke was associated with both CEA and carotid arteriography. In addition, 6 transient ischemic attacks and 3 myocardial infarctions could be directly linked to CEA, for a total CEA event rate of 2.6%. Conclusions Patients with asymptomatic internal carotid artery stenosis exceeding 60% reduction in diameter who are acceptable candidates for elective operation may be considered for CEA if the combined arteriographic and surgical complication rates are 3% or less.
引用
收藏
页码:2216 / 2224
页数:9
相关论文
共 28 条
  • [21] DUPLEX ACCURACY COMPARED WITH ANGIOGRAPHY IN THE VETERANS AFFAIRS COOPERATIVE STUDIES TRIAL FOR SYMPTOMATIC CAROTID STENOSIS
    SRINIVASAN, J
    MAYBERG, MR
    WEISS, DG
    ESKRIDGE, J
    [J]. NEUROSURGERY, 1995, 36 (04) : 648 - 653
  • [22] TOOLE JF, 1989, STROKE, V20, P844
  • [23] 1ST PHASE REPORT OF COOPERATIVE VETERANS-ADMINISTRATION ASYMPTOMATIC CAROTID STENOSIS STUDY - OPERATIVE MORBIDITY AND MORTALITY
    TOWNE, JB
    WEISS, DG
    HOBSON, RW
    [J]. JOURNAL OF VASCULAR SURGERY, 1990, 11 (02) : 252 - 259
  • [24] TOWNE JB, 1980, SURGERY, V88, P575
  • [25] TURNIPSEED WD, 1993, SURGERY, V114, P643
  • [26] ENDARTERECTOMY FOR ASYMPTOMATIC CAROTID-ARTERY STENOSIS
    WALKER, MD
    MARLER, JR
    GOLDSTEIN, M
    GRADY, PA
    TOOLE, JF
    BAKER, WH
    CASTALDO, JE
    CHAMBLESS, LE
    MOORE, WS
    ROBERTSON, JT
    YOUNG, B
    HOWARD, VJ
    PURVIS, S
    VERNON, DD
    NEEDHAM, K
    BECK, P
    DOZIER, M
    LEFKOWITZ, DS
    HOWARD, G
    CROUSE, JR
    HERRINGTON, DM
    FURBERG, CD
    ESSICK, K
    HICKS, RM
    NELSON, JJ
    BALL, W
    BLAND, E
    CONDON, S
    ELLIOTT, T
    GRIZZLE, JE
    HAYES, D
    HENLEY, S
    JOHNSON, J
    LOCKLEAR, J
    MISCH, MS
    PATON, CC
    SCHWARTZ, S
    WALKER, C
    WILLIAMS, OD
    EASTON, JD
    GOLDSTONE, J
    HALLENBECK, JM
    HOFF, JT
    KARP, HR
    KRONMAL, RA
    BROTT, TG
    TOMSICK, TA
    BRODERICK, J
    SAUERBECK, L
    BLUM, C
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1995, 273 (18): : 1421 - 1428
  • [27] YEAGER RA, 1989, ARCH SURG-CHICAGO, V124, P1142
  • [28] COMPARISON OF MAGNETIC-RESONANCE ANGIOGRAPHY, DUPLEX ULTRASOUND, AND DIGITAL SUBTRACTION ANGIOGRAPHY IN ASSESSMENT OF EXTRACRANIAL INTERNAL CAROTID-ARTERY STENOSIS
    YOUNG, GR
    HUMPHREY, PRD
    SHAW, MDM
    NIXON, TE
    SMITH, ETS
    [J]. JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 1994, 57 (12) : 1466 - 1478