A comparative effectiveness study of carotid intervention for long-term stroke prevention in patients with severe asymptomatic stenosis from a large integrated health system.

But you don't tell us how many got a stroke as a direct result of the endarterectomy.

In my non-medical opinion I would never do a carotid endarterectomy as long as the Circle of Willis is complete, I would close up the artery preventing clots from being thrown. Way too many  possible complications from the endarterectomy.

Will your doctor GUARANTEE no complications? Ask your doctor these questions since s/he is supposedly medically trained and I'm not. 

This is why I would never consider a carotid endarterectomy as long as the Circle of Willis is complete. Didn't your doctor tell you of these possible complications?

Possible problems:

Cognitive Dysfunction and Mortality After Carotid Endarterectomy

Carotid Interventions for Women: The Hazards and Benefits

Female Gender Increases Risk of Stroke and Readmission after CEA(Carotid endarterectomy) and CAS(carotid artery stenting)

Ticagrelor Induced Angioedema Following Carotid Artery Stenting

Cognitive Dysfunction and Mortality After Carotid Endarterectomy

 

The latest here:

A comparative effectiveness study of carotid intervention for long-term stroke prevention in patients with severe asymptomatic stenosis from a large integrated health system.

Robert W Chang, Noel Pimentel, Lue-Yen Tucker, Kara A Rothenberg

J Vasc Surg. 2023 Jul 3 [Epub ahead of print]

OBJECTIVE 

 

 The results of current prospective trials comparing the effectiveness of carotid endarterectomy (CEA) versus standard medical therapy for long-term stroke prevention in patients with asymptomatic carotid stenosis (ACS) will not be available for several years. In this study, we compared the observed effectiveness of CEA and standard medical therapy versus standard medical therapy alone to prevent ipsilateral stroke in a contemporary cohort of patients with ACS. METHODS This cohort study was conducted in a large integrated health system in adult subjects with 70-99% ACS (no neurologic symptom within 6 months) with no prior ipsilateral carotid artery intervention. Causal inference methods were used to emulate a conceptual randomized trial using data from 1/1/2008 through 12/31/2017 for comparing the event-free survival over 96 months between two treatment strategies: 1) CEA within 12 months from cohort entry versus 2) no CEA (standard medical therapy alone). To account for both baseline and time-dependent confounding, Inverse Probability Weighting estimation was used to derive adjusted hazard ratios and cumulative risk differences were assessed based on two logistic marginal structural models for counterfactual hazards. Propensity scores were data-adaptively estimated using Super Learning. The primary outcome was ipsilateral anterior ischemic stroke. 

 

RESULTS 

The cohort included 3824 eligible patients with ACS (mean age: 73.7 years, 57.9% male, 12.3% active smokers), of whom 1467 underwent CEA in the first year, while 2297 never underwent CEA. Median follow-up was 68 months. 1760 participants (46%) died, 445 (12%) were lost to follow-up and 158 (4%) patients experienced ipsilateral stroke. The cumulative risk differences for each year of follow-up showed a protective effect of CEA starting in year 2 (risk difference = 1.1%, 95% Confidence Interval (CI): 0.5%-1.6%) persisting to year 8 (2.6%, 95% CI: 0.3%-4.8%) compared with patients not receiving CEA.  

 

CONCLUSIONS 

In this contemporary cohort study of patients with ACS utilizing rigorous analytic methodology, CEA appears to have a small but statistically significant effect on stroke prevention out to 8 years. Further study is needed to appropriately select the subset of patients most likely to benefit from intervention.

Source: Journal of Vascular Surgery