An analysis of perioperative surgical mortality and morbidity in the asymptomatic carotid atherosclerosis study. ACAS Investigators. Asymptomatic Carotid Atherosclerosis Study

Stroke. 1996 Dec;27(12):2216-24. doi: 10.1161/01.str.27.12.2216.

Abstract

Background and purpose: Our aim was to determine the perioperative morbidity and mortality rates of patients in the surgical arm of the multi-institutional, prospective, randomized Asymptomatic Carotid Atherosclerosis Study (ACAS).

Methods: Of 828 patients with carotid stenosis of 60% or more randomized to the surgical arm of ACAS, 721 underwent carotid endarterectomy (CEA). To qualify for participation, surgeons were required to have performed at least 12 CEAs per year with a combined neurological morbidity and mortality rate no greater than 3% for asymptomatic patients and 5% for symptomatic patients. Clinical centers had to demonstrate arteriographic morbidity less than 1% and mortality less than 0.1% per year. Primary events were stroke and death in the period between randomization and 30 days after surgery; secondary events were transient ischemic attack and myocardial infarction occurring in the same period.

Results: Of the 721 patients who underwent CEA, 1 died and 10 others had strokes within 30 days (1.5%). Of the 415 who underwent arteriography after randomization but before CEA, 5 (1.2%) suffered transient ischemic attack or stroke caused by arteriography. Thus, a nearly equal risk of stroke was associated with both CEA and carotid arteriography. In addition, 6 transient ischemic attacks and 3 myocardial infarctions could be directly linked to CEA, for a total CEA event rate of 2.6%.

Conclusions: Patients with asymptomatic internal carotid artery stenosis exceeding 60% reduction in diameter who are acceptable candidates for elective operation may be considered for CEA if the combined arteriographic and surgical complication rates are 3% or less.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Anesthesia
  • Arteriosclerosis / mortality
  • Arteriosclerosis / surgery*
  • Aspirin / therapeutic use
  • Carotid Stenosis / mortality
  • Carotid Stenosis / surgery*
  • Cerebral Infarction / mortality
  • Cerebral Infarction / prevention & control*
  • Combined Modality Therapy
  • Cranial Nerves / physiopathology
  • Death, Sudden / epidemiology
  • Diabetes Mellitus, Type 1 / epidemiology
  • Elective Surgical Procedures* / mortality
  • Endarterectomy, Carotid* / mortality
  • Heart Diseases / complications
  • Humans
  • Hypertension / epidemiology
  • Ischemic Attack, Transient / epidemiology
  • Ischemic Attack, Transient / prevention & control*
  • Myocardial Infarction / complications
  • Myocardial Infarction / epidemiology
  • Myocardial Infarction / prevention & control*
  • Postoperative Complications / mortality*
  • Prospective Studies
  • Smoking / epidemiology
  • Temperance / statistics & numerical data

Substances

  • Aspirin