Abstract:
BACKGROUND AND PURPOSE:Carotid endarterectomy reduces the risk of carotid territory ischemic stroke ipsilateral to a recently symptomatic severe carotid stenosis. However, the benefit is limited by the risks of stroke and death associated with the operation. Although reported surgical risks vary enormously, there has been no systematic review of the published literature. METHODS:We performed a systematic review of mortality and the risk of stroke and/or death due to endarterectomy for symptomatic carotid stenosis in studies published since 1980. RESULTS:Fifty-one studies fulfilled our criteria. Overall mortality was 1.62% (95% confidence interval [CI], 1.3 to 1.9), and the risk of stroke and/or death was 5.64% (95% CI, 4.4 to 6.9). However, there was significant heterogeneity of risk of stroke and/or death (P < .001). The risk varied systematically with the methods and the authorship of the study. The risk of stroke and/or death was highest in studies in which patients were assessed by a neurologist after surgery (7.7%; 95% CI, 5.0 to 10.2) and lowest in studies with a single author affiliated with a department of surgery (2.3%; 95% CI, 1.8 to 2.7). After correcting for study methodology, there was no temporal trend in the risk of stroke and/or death between 1980 and 1995. CONCLUSIONS:The reported risks of endarterectomy for symptomatic carotid stenosis show significantly greater variability than would be expected by chance. However, much of this variability can be accounted for by differences in methodology and authorship. The 5.6% overall risk of stroke and/or death is consistent with present guidelines.
journal_name
Strokejournal_title
Strokeauthors
Rothwell PM,Slattery J,Warlow CPdoi
10.1161/01.str.27.2.260subject
Has Abstractpub_date
1996-02-01 00:00:00pages
260-5issue
2eissn
0039-2499issn
1524-4628journal_volume
27pub_type
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