| carotid stenosis | carotid endarterectomy | not classified | versus placebo or control No demonstrated result for efficacy carotid endarterectomy inferior to control in terms of Perioperative stroke or death in ACAS, 1995 carotid endarterectomy inferior to control in terms of Perioperative stroke or death in VA, 1993 | 6 trials | meta-analysis | | | Trial | control | p<0.05 | harm | NS |
|---|
| ACAS, 1995 | carotid endarterectomy vs control | Perioperative stroke or death or any subsequent stroke 0.71 [0.51; 0.97] Perioperative stroke or death or subsequent ipsilateral stroke 0.64 [0.42; 0.98] | Perioperative stroke or death 6.40 [1.90; 21.55] | Any stroke or death 0.83 [0.67; 1.03] | | ACST, 1994 | carotid endarterectomy vs control | Perioperative stroke or death or any subsequent stroke 0.63 [0.48; 0.82] | | Any stroke or death 0.90 [0.79; 1.03] Perioperative stroke or death or subsequent ipsilateral stroke 0.73 [0.51; 1.03] | | VA, 1993 | carotid endarterectomy vs control | | Perioperative stroke or death 6.63 [1.50; 29.26] | Any stroke or death 0.93 [0.75; 1.16] Perioperative stroke or death or any subsequent stroke 0.92 [0.56; 1.51] Perioperative stroke or death or subsequent ipsilateral stroke 0.78 [0.43; 1.41] | | ECST, 1998 | carotid endarterectomy vs control | | | | | NASCET, 1998 | carotid endarterectomy vs control | | | | | VA309, 1991 | carotid endarterectomy vs control | | | |
| Trial | Treatments | Patients | Method |
|---|
| ACAS, 1995 | carotid endarterectomy, aspirin 325 mg daily (n=825) vs. aspirin 325 mg daily (n=834) | Asymptomatic carotid artery stenosis of 60% or greater | open Parallel groups Sample size: 825/834 Primary endpoint: ipsilateral stroke or any perioperative stroke or death FU duration: 2.7 y mean | | ACST, 1994 | CEA as soon as possible, standard medical treatment including antiplatelet drugs (n=1560) vs. no CEA unless symptoms occurred, standard medical treatment including antiplatelet
drugs (n=1560) | Asymptomatic carotid artery stenosis of 60% or greater | open Parallel groups Sample size: 1560/1560 Primary endpoint: perioperative stroke or death, non-perioperative stroke FU duration: 3.4y mean | | VA, 1993 | carotid endarterectomy aspirin 650 mg bd (n=211) vs. aspirin 650 mg bd (n=233) | Asymptomatic carotid artery stenosis of 50-99% | open Parallel groups Sample size: 211/233 Primary endpoint: ipsilateral neurological eventsm FU duration: 4 y (mean) | | ECST, 1998 | surgery (n=1811) vs. control (n=1213) | men and women of any age, with some degree of carotid stenosis, who within the previous 6 months had had at least one transient or mild symptomatic ischaemic vascular event in the distribution of one or both carotid arteries | open Sample size: 1811/1213 Primary endpoint: FU duration: 6.1 years | | NASCET, 1998 | carotid endarterectomy (n=1108) vs. medical care alone (n=1118) | Patients with moderate (<70%) carotid stenosis and transient ischemic attacks or nondisabling strokes on the same side as the stenosis (ipsilateral) within 180 days | open Sample size: 1108/1118 Primary endpoint: FU duration: 5 years | | VA309, 1991 | Carotid endarterectomy plus the best medical care (n=91) vs. best medical care alone (n=98) | Men who presented within 120 days of onset of symptoms that were consistent with transient ischemic attacks, transient monocular blindness, or recent small completed strokes and with with angiographic internal carotid artery stenosis greater than 50% ipsilateral to the presenting symptoms | open Sample size: 91/98 Primary endpoint: FU duration: 11.9 months |
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