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Endarterectomy for moderate symptomatic carotid stenosis : interim results from the MRC European carotid surgery trial

(1996) LANCET. 347(9015). p.1591-1593
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Abstract
Background The objective of this study was to assess whether carotid endarterectomy is an appropriate treatment for patients with recent cerebrovascular events in the territory supplied by a moderately stenosed (30-69%) internal carotid artery. Results have previously been reported for severe (70-99%) and mild (0-29%) stenosis. Methods A multicentre randomised controlled trial recruited 1599 patients with moderate stenosis treated in 97 hospitals from 15 countries, 60% of patients were allocated to receive and 40% to avoid carotid endarterectomy. The analysis was by intention to treat. Findings Nine patients were omitted from the analysis because no follow-up data were received. Stroke-free life expectancy (curtailed at 8 years) was shorter in the surgery patients than in the non-surgery control groups (patients with 30-49% stenosis, life expectancy=6.16 years [controls: 6.63 years]; patients with 50-69% stenosis, life expectancy=5.93 [6.14] years). It remains possible that patients might derive some benefit from surgery in the very long term; however, our data show that no benefit would be gained over a period of <4-5 years in patients with 50-69% stenosis and <6-7 years in patients with 30-49% stenosis. Interpretation Previous interim results from this study showed that surgery is beneficial in patients with severe stenosis but harmful in those with mild stenosis. With more randomised patients and longer follow-up, the study now shows that endarterectomy is not indicated for most, possibly all, patients with moderate symptomatic carotid stenosis.

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Citation

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Chicago
European Carotid Surgery Trialists’ Collaborative Group, the, W Ceusters, Jacques De Reuck, J De Roose, D Decoo, D Derom, and A Vakaet. 1996. “Endarterectomy for Moderate Symptomatic Carotid Stenosis : Interim Results from the MRC European Carotid Surgery Trial.” Lancet 347 (9015): 1591–1593.
APA
European Carotid Surgery Trialists’ Collaborative Group, the, Ceusters, W., De Reuck, J., De Roose, J., Decoo, D., Derom, D., & Vakaet, A. (1996). Endarterectomy for moderate symptomatic carotid stenosis : interim results from the MRC European carotid surgery trial. LANCET, 347(9015), 1591–1593.
Vancouver
1.
European Carotid Surgery Trialists’ Collaborative Group the, Ceusters W, De Reuck J, De Roose J, Decoo D, Derom D, et al. Endarterectomy for moderate symptomatic carotid stenosis : interim results from the MRC European carotid surgery trial. LANCET. 1996;347(9015):1591–3.
MLA
European Carotid Surgery Trialists’ Collaborative Group, the, W Ceusters, Jacques De Reuck, et al. “Endarterectomy for Moderate Symptomatic Carotid Stenosis : Interim Results from the MRC European Carotid Surgery Trial.” LANCET 347.9015 (1996): 1591–1593. Print.
@article{261667,
  abstract     = {Background The objective of this study was to assess whether carotid endarterectomy is an appropriate treatment for patients with recent cerebrovascular events in the territory supplied by a moderately stenosed (30-69\%) internal carotid artery. Results have previously been reported for severe (70-99\%) and mild (0-29\%) stenosis. 
Methods A multicentre randomised controlled trial recruited 1599 patients with moderate stenosis treated in 97 hospitals from 15 countries, 60\% of patients were allocated to receive and 40\% to avoid carotid endarterectomy. The analysis was by intention to treat. 
Findings Nine patients were omitted from the analysis because no follow-up data were received. Stroke-free life expectancy (curtailed at 8 years) was shorter in the surgery patients than in the non-surgery control groups (patients with 30-49\% stenosis, life expectancy=6.16 years [controls: 6.63 years]; patients with 50-69\% stenosis, life expectancy=5.93 [6.14] years). It remains possible that patients might derive some benefit from surgery in the very long term; however, our data show that no benefit would be gained over a period of {\textlangle}4-5 years in patients with 50-69\% stenosis and {\textlangle}6-7 years in patients with 30-49\% stenosis. 
Interpretation Previous interim results from this study showed that surgery is beneficial in patients with severe stenosis but harmful in those with mild stenosis. With more randomised patients and longer follow-up, the study now shows that endarterectomy is not indicated for most, possibly all, patients with moderate symptomatic carotid stenosis.},
  author       = {European Carotid Surgery Trialists' Collaborative Group, the and Ceusters, W and De Reuck, Jacques and De Roose, J and Decoo, D and Derom, D and Vakaet, A},
  issn         = {0140-6736},
  journal      = {LANCET},
  language     = {eng},
  number       = {9015},
  pages        = {1591--1593},
  title        = {Endarterectomy for moderate symptomatic carotid stenosis : interim results from the MRC European carotid surgery trial},
  url          = {http://dx.doi.org/10.1016/S0140-6736(96)91077-6},
  volume       = {347},
  year         = {1996},
}

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