An analysis of perioperative surgical mortality and morbidity in the asymptomatic carotid atherosclerosis study. ACAS Investigators. Asymptomatic Carotid Atherosclerosis Study
| Autor: | B, Young, W S, Moore, J T, Robertson, J F, Toole, C B, Ernst, S N, Cohen, J P, Broderick, R J, Dempsey, J D, Hosking |
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| Rok vydání: | 1996 |
| Předmět: |
Endarterectomy
Carotid Aspirin Heart Diseases Arteriosclerosis Temperance Smoking Cranial Nerves Myocardial Infarction Cerebral Infarction Combined Modality Therapy Death Sudden Diabetes Mellitus Type 1 Postoperative Complications Elective Surgical Procedures Ischemic Attack Transient Hypertension Humans Anesthesia Carotid Stenosis Prospective Studies |
| Zdroj: | Stroke. 27(12) |
| ISSN: | 0039-2499 |
| Popis: | 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).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.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%.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. |
| Databáze: | OpenAIRE |
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