Endarterectomy for asymptomatic XXXX . Executive Committee for the Asymptomatic Carotid Atherosclerosis Study.

@entity1 @entity64 @entity63 @entity117 @entity543 @entity204 @entity385
OBJECTIVE: To determine whether the addition of carotid endarterectomy to aggressive medical management can reduce the incidence of @entity385 in @entity1 with asymptomatic @entity543 . DESIGN: Prospective, randomized, multicenter trial. SETTING: Thirty-nine clinical sites across the United States and Canada. @entity1 : Between December 1987 and December 1993, a total of 1662 @entity1 with asymptomatic @entity543 of 60% or greater reduction in diameter were randomized; follow-up data are available on 1659. At baseline, recognized risk factors for @entity64 were similar between the two treatment groups. INTERVENTION: Daily @entity117 administration and medical risk factor management for all @entity1 ; carotid endarterectomy for @entity1 randomized to receive surgery. MAIN OUTCOME MEASURES: Initially, transient @entity63 attack or @entity385 occurring in the distribution of the study artery and any transient @entity63 attack, @entity64 , or @entity204 occurring in the perioperative period. In March 1993, the primary outcome measures were changed to @entity385 occurring in the distribution of the study artery or any @entity64 or @entity204 occurring in the perioperative period. RESULTS: After a median follow-up of 2.7 years, with 4657 @entity1 -years of observation, the aggregate risk over 5 years for @entity64 and any perioperative @entity64 or @entity204 was estimated to be 5.1% for surgical @entity1 and 11.0% for @entity1 treated medically (aggregate risk reduction of 53% [95% confidence interval, 22% to 72%]). CONCLUSION: @entity1 with asymptomatic @entity543 of 60% or greater reduction in diameter and whose general health makes them good candidates for elective surgery will have a reduced 5-year risk of @entity64 if carotid endarterectomy performed with less than 3% perioperative morbidity and mortality is added to aggressive management of modifiable risk factors.
