Benefit of CEA in different conditions

Degree of stensois         Studies        Recc           Risk reduction

 

Symptomatic stenosis

   70-99%                       NASCET     CEA LEVEL A       16.5 % at two years

   >60 %                         ECST               "                     11.6 % at 3 years

   50-69 %                       NASCET           "                    10.1 % at 5 years

 

 

Asymptomatic stenosis

 

>60 %                            ACAS, ACST     "                     6.3 % at five years

RISK OF HEMORRHAGE

 

-- some literature favors early surgery for patients without early ICH on CT scans

 

-- of those who hemorrhaged, hemorhhage occured 3-6 days after surgery when patients were improving or ambulatory.  They occurred in 6/900 patients studied

 

-- Dosick et al. reported 9.5 % restroke incidence with six week waiting period before CEA

 

--In NASCET 4.9 % of 103 patients  (5 patients) had restroke within 30 days of trial entry if treated medically

 

-- In a variety of studies patients operated within 3 weeks had 3 % stroke risk, those operated beyong 3 weeks had a 5.3 % stroke risk