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Therapeutics
Immediate carotid endarterectomy reduced non-perioperative stroke in severe asymptomatic carotid artery stenosis

https://doi.org/10.1136/ebm.9.5.145

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    Halliday A, Mansfield A, Marro J, et al. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet 2004;363:1491–502.
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 Q In patients with severe carotid artery stenosis but no recent (⩽6 mo) stroke or ischaemia, is immediate carotid endarterectomy (CEA) more effective than indefinite deferral of any CEA for reducing perioperative mortality and morbidity and incidence of non-perioperative stroke?

    Clinical impact ratings GP/FP/Primary care ★★★★★☆☆ IM/Ambulatory care ★★★★★★★ Internal medicine ★★★★★★★ Cardiology ★★★★★★★ Geriatrics ★★★★★★★ Neurology ★★★★★★☆

    METHODS

    Embedded ImageDesign:

    randomised controlled trial (MRC Asymptomatic Carotid Surgery Trial [ACST]).

    Embedded ImageAllocation:

    concealed.*

    Embedded ImageBlinding:

    blinded (endpoint review committee).*

    Embedded ImageFollow up period:

    up to 5 years (mean 3.4 y).

    Embedded ImageSetting:

    126 hospitals in 30 countries.

    Embedded ImagePatients:

    3120 patients (mean age 68 y, 66% men) who had severe unilateral or bilateral carotid artery stenosis (⩾60% diameter reduction on ultrasonography) but no stroke or ischaemia in the previous 6 months, for whom both physician and patient were substantially uncertain whether to choose immediate CEA or …

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