TY  - JOUR
T1  - NAtional stroke association guidelines to prevent stroke
AU  - Chaturvedi S
Y1  - 1999/12/01
N1  - 10-1001/pubs.JAMA-ISSN-0098-7484-282-21-jbk1201
JO  - JAMA
SP  - 1999
EP  - 2001
VL  - 282
IS  - 21
N2  - 
The guidelines state that CE is useful in individuals with asymptomatic
carotid narrowing of greater than 60% if the surgery can be performed with
a morbidity and mortality rate of less than 3%. This claim is based on a single
study, the Asymptomatic Carotid Atherosclerosis Surgery (ACAS) trial, of dubious
generalizability.2 The ACAS enrolled only
select, low-risk patients. Twenty-five patients were screened clinically and
from ultrasound laboratories for every 1 patient entered in the study. In
addition, the surgeons in ACAS were vetted for excellence in their work: they
had to provide evidence of a recent complication rate of less than 3%. Indeed,
one third of the surgeons who applied were either rejected or did not complete
the certification process. Overall perioperative mortality in ACAS was 0.1%.
Perioperative mortality for the group of surgeons not given credentials by
ACAS was 2.2%, 22 times higher than that seen in the clinical trial results.
There are also performance data available suggesting that the surgical proficiency
observed in ACAS is not duplicated in clinical practice. In the recently completed
Aspirin and Carotid Endarterectomy Study, in which close to 1700 patients
were asymptomatic, the stroke and death rate in asymptomatic patients was
4.6%, higher than the NSA threshold of less than 3% (W. Taylor, PhD, written
communication September 1998).

SN  - 0098-7484
M3  - doi: 10-1001/pubs.JAMA-ISSN-0098-7484-282-21-jbk1201
UR  - http://dx.doi.org/10-1001/pubs.JAMA-ISSN-0098-7484-282-21-jbk1201
ER  -