asymptomatic carotid stenosis病人，immediate carotid enarterectomy可預防中風，效力達十年!(ACST-1)

在無症狀的病人，做CEA，5年時immediate vs. deferred 3.8% vs. 11% cva risk

10年時，10.8% vs. 16.9%，仍有差異

In Asymptomatic Carotid Stenosis, Endarterectomy Prevents Strokes for at Least 10 Years

Benefits seen at 5 years persisted at 10 years.

In patients with asymptomatic moderate-to-severe carotid artery stenosis, endarterectomy lowers long-term risk for stroke but carries substantial risk for perioperative stroke or death. In one study, started in 1993, investigators randomized 3120 such patients to immediate endarterectomy or no immediate intervention (with the option to elect endarterectomy at any time and for any reason). In a 2004 report from this international group, immediate endarterectomy carried a 3% perioperative risk for stroke or death, and the 5-year risk for nonperioperative stroke was significantly lower in the endarterectomy group than in the deferred-intervention group (3.8% vs. 11.0%) (JW Gen Med May 21 2004).

Investigators now report on these patients 5 years later. By this time, 26% of deferred-intervention patients had undergone endarterectomies, and their risk for perioperative stroke or death remained about 3%. After as long as 10 years of follow-up, patients initially assigned to immediate endarterectomy continued to have significantly fewer nonperioperative strokes (10.8% vs. 16.9%). Most patients took antiplatelet and antihypertensive medications throughout the trial. Patients who took lipid-lowering drugs had a lower absolute stroke rate than those who did not, but endarterectomy lowered stroke rates similarly in both groups. People whose age at enrollment was ≥75 did not benefit from endarterectomy.

Comment: The absolute benefit of early endarterectomy observed in the first 5 years after randomization persisted in the subsequent 5 years. The benefit of endarterectomy will be greatest in patients with a life expectancy of more than 10 years; patients with shorter life expectancy have fewer years of benefit to offset the initial risk for perioperative stroke or death.

— Bruce Soloway, MD

Published in Journal Watch General Medicine October 14, 2010

Citation(s):

Halliday A et al. 10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis (ACST-1): A multicentre randomised trial. Lancet 2010 Sep 25; 376:1074. (http://dx.doi.org/10.1016/S0140-6736(10)61197-X)

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