Asymptomatic Carotid Surgery Trial
The largest multicenter randomized trial to date 1) revealed a moderate benefit for immediate CEA vs. medical management in patients age < 75 with asymptomatic stenosis ≥ 60%.
Details: 3,120 patients with≥60% stenosis by duplex ultrasound were randomized to immediate CEA (50% had CEA within 1 month, 88% within 1 year) or medical therapy at the discretion of the treating physician. Mean follow-up: 3.4 years.
Exclusion criteria included: poor surgical risk, prior ipsilateral CEA, and probable cardiac emboli. Surgeons were required to have a perioperative morbidity and mortality rate of < 6%.
The net five-year risk for all stroke or perioperative stroke or death: 6.4% in the CEA group, vs. 11.8% in the medical group (p < 0.0001). Fatal or disabling stroke: 3.5 vs. 6.1%. Fatal stroke alone: 2.1 vs. 4.2%. Although men and women benefited, men benefited more. CEA did not demonstrate a statistically significant benefit for patients over the age of 75. The statistical benefit was not seen in the immediate CEA group until nearly two years after surgery, despite a relatively low perioperative morbidity and mortality rate of 3.1%, (in contrast to patients with symptomatic stenosis (NASCET 2)) where the benefit was seen much earlier).