The Neurologist 2002;8; 203-4.
1. NASCET showed in symptomatic patients with 70-99 % angiographic stenosis, there was a 2 year absolute benefit of 17%, which equate to a NNT of 6. In the 50-69 % group, there was a modest benefit of 1.3 % per year (NNT of 15 for ipsilateral stroke and NNT of 23 for disabling ipsilateral stroke. The author suggests CEA in the 50-69 % group only for those with 2 of the three following: male gender, ulcerated lesions, hemispheric ischemia. Blogger's note: the second suggested criteria is more subjective than thought at first read, and diabetes (absence of) also should be taken into account.
2. ACAS showed that in asymptomatic patients with 60-99 % stenosis, the benefit of 1.2 % per year has a NTT of 67.
3. Perioperative stroke in emergent CEA with progressive stroke of <24 20="" and="" as="" br="" day.="" definition="" does="" duration="" gray="" high="" hours="" is="" mean="" necessarily="" not="" of="" operating="" somewhat="" suggesting="" that="" the="" urgently="">
4. The elderly benefit from CEA, but also have higher perioperative complications.
5. The stroke / death rate in NASCET following CEA was 6.5 %. In ACE trial it was 4.6 %, higher than the benefit of the surgery.
Robert Brown's analysis:
Carotid stenosis >70 %, symptomatic, NASCET risk of ipsilateral stroke
*surgery 9 % over 2 years
*medical 26 % over 2 years
* abs rr 8.5 % per year NNT=12
50-70%
* surgery 16 %/5 years
*best medical 22 % over 5 years
* benefit 1.2 %/yr NNT-83
< 50 % no benefit
1. NASCET showed in symptomatic patients with 70-99 % angiographic stenosis, there was a 2 year absolute benefit of 17%, which equate to a NNT of 6. In the 50-69 % group, there was a modest benefit of 1.3 % per year (NNT of 15 for ipsilateral stroke and NNT of 23 for disabling ipsilateral stroke. The author suggests CEA in the 50-69 % group only for those with 2 of the three following: male gender, ulcerated lesions, hemispheric ischemia. Blogger's note: the second suggested criteria is more subjective than thought at first read, and diabetes (absence of) also should be taken into account.
2. ACAS showed that in asymptomatic patients with 60-99 % stenosis, the benefit of 1.2 % per year has a NTT of 67.
3. Perioperative stroke in emergent CEA with progressive stroke of <24 20="" and="" as="" br="" day.="" definition="" does="" duration="" gray="" high="" hours="" is="" mean="" necessarily="" not="" of="" operating="" somewhat="" suggesting="" that="" the="" urgently="">
4. The elderly benefit from CEA, but also have higher perioperative complications.
5. The stroke / death rate in NASCET following CEA was 6.5 %. In ACE trial it was 4.6 %, higher than the benefit of the surgery.
Robert Brown's analysis:
Carotid stenosis >70 %, symptomatic, NASCET risk of ipsilateral stroke
*surgery 9 % over 2 years
*medical 26 % over 2 years
* abs rr 8.5 % per year NNT=12
50-70%
* surgery 16 %/5 years
*best medical 22 % over 5 years
* benefit 1.2 %/yr NNT-83
< 50 % no benefit
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