European Journal of Vascular & Endovascular Surgery
Volume 35, Issue 5 , Pages 524-533 , May 2008

Does the ‘High Risk’ Patient with Asymptomatic Carotid Stenosis Really Exist?

  • A.L. Abbott

      Affiliations

    • National Stroke Research Institute, Austin Health, Melbourne, Australia
    • Baker Heart Research Institute, Melbourne, Australia
    • Corresponding Author InformationCorresponding author. Dr. A. L. Abbott, MBBS, PhD, National Stroke Research Institute, Austin Health, Level 1, Neurosciences Building, Banksia Street, Heidelberg West, Victoria 3081, Australia.
    • ,
  • G.A. Donnan

      Affiliations

    • National Stroke Research Institute, Austin Health, Melbourne, Australia
    • Neurology Department, Austin Health, Melbourne, Australia
    • The University of Melbourne, Australia

,Accepted 29 January 2008.

References 

  1. Abbott A, Bladin C, Levi C, Chambers B. What should we do with asymptomatic carotid stenosis?. Int J Stroke. 2007;2:27–39
  2. Yadav JS, Wholey MH, Kuntz RE, Fayad P, Katzen BT, Mishkel GJ, et al. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med. 2004;351:1493–1501
  3. Moussa I, Rundek T, Mohr JE. Asymptomatic carotid artery stenosis: Risk stratification and management. London: Informa Healthcare; 2007;
  4. Halliday A, Mansfield A, Marro J, Peto C, Peto R, Potter J, et al. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet. 2004;363:1491–1502
  5. Inzitari D, Eliasziw M, Gates P, Sharpe BL, Chan RK, Meldrum HE, et al. The causes and risk of stroke in patients with asymptomatic internal-carotid-artery stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators N Engl J Med. 2000;342:1693–1700
  6. Johnson JM, Kennelly MM, Decesare D, Morgan S, Sparrow A. Natural history of asymptomatic carotid plaque. Arch Surg. 1985;120:1010–1012
  7. Chambers BR, Norris JW. Outcome in patients with asymptomatic neck bruits. N Engl J Med. 1986;315:860–865
  8. Hobson RW, Weiss DG, Fields WS, Goldstone J, Moore WS, Towne JB, et al. Efficacy of carotid endarterectomy for asymptomatic carotid stenosis. The Veterans Affairs Cooperative Study Group N Engl J Med. 1993;328:221–227
  9. European Carotid Surgery Trialists' Collaborative Group. Risk of stroke in the distribution of an asymptomatic carotid artery. Lancet. 1995;345:209–212
  10. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study . Endarterectomy for asymptomatic carotid artery stenosis. JAMA. 1995;273:1421–1428
  11. Mackey AE, Abrahamowicz M, Langlois Y, Battista R, Simard D, Bourque F, et al. Outcome of asymptomatic patients with carotid disease. Asymptomatic Cervical Bruit Study Group Neurology. 1997;48:896–903
  12. Nicolaides AN, Kakkos S, Griffin M, Sabetai M, Dhanjil S, Tegos T, et al. Severity of asymptomatic carotid stenosis and risk of ipsilateral hemispheric ischaemic events: results from the ACSRS Study. Eur J Vasc Endovasc Surg. 2005;30:275–284
  13. Abbott AL, Chambers BR, Stork JL, Levi CR, Bladin CF, Donnan GA. Embolic signals and prediction of ipsilateral stroke or transient ischemic attack in asymptomatic carotid stenosis: a multicenter prospective cohort study. Stroke. 2005;36:1128–1133
  14. Goessens BM, Visseren FL, Kappelle LJ, Algra A, van der Graaf Y. Asymptomatic carotid artery stenosis and the risk of new vascular events in patients with manifest arterial disease: the SMART Study. Stroke. 2007;38:1470–1475
  15. Nicolaides AN, Kakkos S, Griffin M, Geroulakos G, Ioannidou E. Severity of asymptomatic carotid stenosis and risk of ipsilateral hemispheric ischaemic events: results from the ACSRS study. Eur J Vasc Endovasc Surg. 2006;31:336
  16. Bonita R, Beaglehole R, North JD. Event, incidence and case fatality rates of cerebrovascular disease in Auckland, New Zealand. Am J Epidemiol. 1984;120:236–243
  17. Anderson CS, Jamrozik KD, Burvill PW, Chakera TM, Johnson GA, Stewart-Wynne EG. Ascertaining the true incidence of stroke: experience from the Perth Community Stroke Study, 1989–1990. Med J Aust. 1993;158:80–84
  18. Thrift AG, Dewey HM, Macdonell RA, McNeil JJ, Donnan GA. Stroke incidence on the east coast of Australia: the North East Melbourne Stroke Incidence Study (NEMESIS). Stroke. 2000;31:2087–2092
  19. Torvik A, Joergensen L. Thrombotic and embolic occlusions of the carotid arteries in an autopsy material. I. Prevalence, location and associated diseases. J Neurol Sci. 1964;41:24–39
  20. Solberg LA, Eggen DA. Localization and sequence of development of atherosclerotic lesions in the carotid and vertebral arteries. Circulation. 1971;43:711–724
  21. Hellings WE, Pasterkamp G, Verhoeven BA, De Kleijn DP, De Vries JP, Seldenrijk KA, et al. Gender-associated differences in plaque phenotype of patients undergoing carotid endarterectomy. J Vasc Surg. 2007;45:289–296[discussion 296–287]
  22. Dick P, Sherif C, Sabeti S, Amighi J, Minar E, Schillinger M. Gender differences in outcome of conservatively treated patients with asymptomatic high grade carotid stenosis. Stroke. 2005;36:1178–1183
  23. Hankey GJ, Slattery JM, Warlow CP. Can the long term outcome of individual patients with transient ischaemic attacks be predicted accurately?. J Neurol Neurosurg Psychiatr. 1993;56:752–759
  24. Nicolaides A, Sabetai M, Kakkos SK, Dhanjil S, Tegos T, Stevens JM, et al. The asymptomatic carotid stenosis and risk of stroke (ACSRS) study. Aims and results of quality control. Int Angiol. 2003;22:263–272
  25. Wald NJ, Law MR. A strategy to reduce cardiovascular disease by more than 80%. BMJ. 2003;326:1419
  26. European Carotid Surgery Trialists' Collaborative Group. MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70–99%) or with mild (0–29%) carotid stenosis. Lancet. 1991;337:1235–1243
  27. Corrado E, Rizzo M, Tantillo R, Muratori I, Bonura F, Vitale G, et al. Markers of inflammation and infection influence the outcome of patients with baseline asymptomatic carotid lesions: a 5-year follow-up study. Stroke. 2006;37:482–486
  28. Daskalopoulou SS, Daskalopoulos ME, Perrea D, Nicolaides AN, Liapis CD. Carotid artery atherosclerosis: what is the evidence for drug action?. Curr Pharm Des. 2007;13:1141–1159
  29. Oei HH, van der Meer IM, Hofman A, Koudstaal PJ, Stijnen T, Breteler MM, et al. Lipoprotein-associated phospholipase A2 activity is associated with risk of coronary heart disease and ischemic stroke: the Rotterdam Study. Circulation. 2005;111:570–575
  30. Nygard O, Nordrehaug JE, Refsum H, Ueland PM, Farstad M, Vollset SE. Plasma homocysteine levels and mortality in patients with coronary artery disease. N Engl J Med. 1997;337:230–236
  31. Wald DS, Law M, Morris JK. Homocysteine and cardiovascular disease: evidence on causality from a meta-analysis. BMJ. 2002;325:1202
  32. VITATOPS Trial Study Group . The VITATOPS (Vitamins to Prevent Stroke) Trial: rationale and design of an international, large, simple, randomised trial of homocysteine-lowering multivitamin therapy in patients with recent transient ischaemic attack or stroke. Cerebrovasc Dis. 2002;13:120–126
  33. AbuRahma AF, Cook CC, Metz MJ, Wulu JT, Bartolucci A. Natural history of carotid artery stenosis contralateral to endarterectomy: results from two randomized prospective trials. J Vasc Surg. 2003;38:1154–1161
  34. Golemati S, Sassano A, Lever MJ, Bharath AA, Dhanjil S, Nicolaides AN. Carotid artery wall motion estimated from B-mode ultrasound using region tracking and block matching. Ultrasound Med Biol. 2003;29:387–399
  35. Bock RW, Gray-Weale AC, Mock PA, App Stats M, Robinson DA, Irwig L, et al. The natural history of asymptomatic carotid artery disease. J Vasc Surg. 1993;17:160–169[discussion 170–171]
  36. Carra G, Visona A, Bonanome A, Lusiani L, Pesavento R, Bortolon M, et al. Carotid plaque morphology and cerebrovascular events. Int Angiol. 2003;22:284–289
  37. Kitamura A, Iso H, Imano H, Ohira T, Okada T, Sato S, et al. Carotid intima-media thickness and plaque characteristics as a risk factor for stroke in Japanese elderly men. Stroke. 2004;35:2788–2794
  38. Prabhakaran S, Rundek T, Ramas R, Elkind MS, Paik MC, Boden-Albala B, et al. Carotid plaque surface irregularity predicts ischemic stroke: the Northern Manhattan Study. Stroke. 2006;37:2696–2701
  39. Sterpetti AV, Schultz RD, Feldhaus RJ, Davenport KL, Richardson M, Farina C, et al. Ultrasonographic features of carotid plaque and the risk of subsequent neurologic deficits. Surgery. 1988;104:652–660
  40. Langsfeld M, Gray-Weale AC, Lusby RJ. The role of plaque morphology and diameter reduction in the development of new symptoms in asymptomatic carotid arteries. J Vasc Surg. 1989;9:548–557
  41. Belcaro G, Laurora G, Cesarone MR, De Sanctis MT, Incandela L, Fascetti E, et al. Ultrasonic classification of carotid plaques causing less than 60% stenosis according to ultrasound morphology and events. J Cardiovasc Surg (Torino). 1993;34:287–294
  42. Polak JF, O'Leary DH, Kronmal RA, Wolfson SK, Bond MG, Tracy RP, et al. Sonographic evaluation of carotid artery atherosclerosis in the elderly: relationship of disease severity to stroke and transient ischemic attack. Radiology. 1993;188:363–370
  43. Nicolaides AN, Kakkos SK, Griffin M, Sabetai M, Dhanjil S, Thomas DJ, et al. Effect of image normalization on carotid plaque classification and the risk of ipsilateral hemispheric ischemic events: results from the Asymptomatic Carotid Stenosis and Risk of Stroke Study. Vascular. 2005;13:211–221
  44. Hennerici M, Meairs S. Imaging arterial wall disease. Cerebrovasc Dis. 2000;10(Suppl. 5):9–20
  45. Schumacher H, Kaiser E, Schnabel PA, Sykora J, Eckstein HH, Allenberg JR. Immunophenotypic characterisation of carotid plaque: increased amount of inflammatory cells as an independent predictor for ischaemic symptoms. Eur J Vasc Endovasc Surg. 2001;21:494–501
  46. Davies JR, Rudd JH, Weissberg PL, Narula J. Radionuclide imaging for the detection of inflammation in vulnerable plaques. J Am Coll Cardiol. 2006;47:C57–C68
  47. Fisher CM, Ojemann RG. A clinico-pathologic study of carotid endarterectomy plaques. Rev Neurol (Paris). 1986;142:573–589
  48. Bassiouny HS, Davis H, Massawa N, Gewertz BL, Glagov S, Zarins CK. Critical carotid stenoses: morphologic and chemical similarity between symptomatic and asymptomatic plaques. J Vasc Surg. 1989;9:202–212
  49. Svindland A, Torvik A. Atherosclerotic carotid disease in asymptomatic individuals: an histological study of 53 cases. Acta Neurol Scand. 1988;78:506–517
  50. Golledge J, Greenhalgh RM, Davies AH. The symptomatic carotid plaque. Stroke. 2000;31:774–781
  51. Fisher M, Paganini-Hill A, Martin A, Cosgrove M, Toole JF, Barnett HJ, et al. Carotid plaque pathology: thrombosis, ulceration, and stroke pathogenesis. Stroke. 2005;36:253–257
  52. Lennihan L, Kupsky WJ, Mohr JP, Hauser WA, Correll JW, Quest DO. Lack of association between carotid plaque hematoma and ischemic cerebral symptoms. Stroke. 1987;18:879–881
  53. Rothwell PM, Gibson R, Warlow CP. Interrelation between plaque surface morphology and degree of stenosis on carotid angiograms and the risk of ischemic stroke in patients with symptomatic carotid stenosis. On behalf of the European Carotid Surgery Trialists' Collaborative Group Stroke. 2000;31:615–621
  54. Leahy AL, McCollum PT, Feeley TM, Sugrue M, Grouden MC, O'Connell DJ, et al. Duplex ultrasonography and selection of patients for carotid endarterectomy: plaque morphology or luminal narrowing?. J Vasc Surg. 1988;8:558–562
  55. Abbott AL. Natural history of high-grade asymptomatic carotid stenosis and identification of high ipsilateral stroke or TIA risk using microembolus detection. Thesis, The University of Melbourne, Department of Medicine; 2004. p. 438.
  56. Abbott AL, Levi CR, Stork JL, Donnan GA, Chambers BR. Timing of clinically significant microembolism after carotid endarterectomy. Cerebrovasc Dis. 2007;23:362–367
  57. Spence JD, Tamayo A, Lownie SP, Ng WP, Ferguson GG. Absence of microemboli on transcranial Doppler identifies low-risk patients with asymptomatic carotid stenosis. Stroke. 2005;36:2373–2378
  58. Markus HS, Cullinane M. Asymptomatic carotid emboli (ACES) study. Cerebrovasc Dis. 2000;10(Suppl. 1):3
  59. Markus H, Cullinane M. Severely impaired cerebrovascular reactivity predicts stroke and TIA risk in patients with carotid artery stenosis and occlusion. Brain. 2001;124:457–467
  60. Derdeyn CP, Grubb RL, Powers WJ. Cerebral hemodynamic impairment: methods of measurement and association with stroke risk. Neurology. 1999;53:251–259
  61. van der Grond J, Balm R, Kappelle LJ, Eikelboom BC, Mali WP. Cerebral metabolism of patients with stenosis or occlusion of the internal carotid artery. A 1H-MR spectroscopic imaging study. Stroke. 1995;26:822–828
  62. Norris JW, Zhu CZ. Silent stroke and carotid stenosis. Stroke. 1992;23:483–485
  63. Chambers BR, Donnan GA. Carotid endarterectomy for asymptomatic carotid stenosis. Cochrane Database Syst Rev. 2005;CD001923
  64. Beebe HG, Clagett GP, DeWeese JA, Moore WS, Robertson JT, Sandok B, et al. Assessing risk associated with carotid endarterectomy. A statement for health professionals by an ad hoc committee on carotid surgery standards of the Stroke Council, American Heart Association. Circulation. 1989;79:472–473
  65. Young B, Moore WS, Robertson JT, Toole JF, Ernst CB, Cohen SN, et al. An analysis of perioperative surgical mortality and morbidity in the Asymptomatic Carotid Atherosclerosis Study. ACAS investigators Stroke. 1996;27:2216–2224
  66. Goldstein LB, Adams R, Becker K, Furberg CD, Gorelick PB, Hademenos G, et al. Primary prevention of ischemic stroke: a statement for healthcare professionals from the Stroke Council of the American Heart Association. Stroke. 2001;32:280–299
  67. Goldstein LB, Adams R, Becker K, Furberg CD, Gorelick PB, Hademenos G, et al. Primary prevention of ischemic stroke: a statement for healthcare professionals from the Stroke Council of the American Heart Association. Circulation. 2001;103:163–182
  68. Wennberg DE, Lucas FL, Birkmeyer JD, Bredenberg CE, Fisher ES. Variation in carotid endarterectomy mortality in the Medicare population: Trial hospitals, volume, and patient characteristics. JAMA. 1998;279:1278–1281
  69. Taylor DW, Barnett HJ, Haynes RB, Ferguson GG, Sackett DL, Thorpe KE, et al. Low-dose and high-dose acetylsalicylic acid for patients undergoing carotid endarterectomy: a randomised controlled trial. ASA and carotid endarterectomy (ACE) Trial Collaborators Lancet. 1999;353:2179–2184
  70. Bond R, Rerkasem K, Rothwell P. High morbidity and mortality due to endarterectomy for asymptomatic carotid stenosis (abs). Cerebrovasc Dis. 2003;16(Suppl. 4):65–66
  71. Rothwell PM, Goldstein LB. Carotid endarterectomy for asymptomatic carotid stenosis: Asymptomatic Carotid Surgery Trial. Stroke. 2004;35:2425–2427
  72. Kresowik TF, Bratzler DW, Kresowik RA, Hendel ME, Grund SL, Brown KR, et al. Multistate improvement in process and outcomes of carotid endarterectomy. J Vasc Surg. 2004;39:372–380
  73. Gray WA, Hopkins LN, Yadav S, Davis T, Wholey M, Atkinson R, et al. Protected carotid stenting in high-surgical-risk patients: the ARCHeR results. J Vasc Surg. 2006;44:258–268
  74. Safian RD, Bresnahan JF, Jaff MR, Foster M, Bacharach JM, Maini B, et al. Protected carotid stenting in high-risk patients with severe carotid artery stenosis. J Am Coll Cardiol. 2006;47:2384–2389
  75. Hobson RW, Howard VJ, Roubin GS, Brott TG, Ferguson RD, Popma JJ, et al. Carotid artery stenting is associated with increased complications in octogenarians: 30-day stroke and death rates in the CREST lead-in phase. J Vasc Surg. 2004;40:1106–1111
  76. CaRESS Steering Committee . Carotid revascularization using endarterectomy or stenting systems (CaRESS) phase 1 clinical trial: 1-year results. J Vasc Surg. 2005;42:213–219
  77. Katzen BT. The Transatlantic Asymptomatic Carotid Intervention Trial. Endovascular Today. 2005 September;49–50
  78. CAVATAS Investigators . Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomised trial. Lancet. 2001;357:1729–1737
  79. Mas JL, Chatellier G, Beyssen B, Branchereau A, Moulin T, Becquemin JP, et al. Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med. 2006;355:1660–1671
  80. Ringleb PA, Allenberg J, Bruckmann H, Eckstein HH, Fraedrich G, Hartmann M, et al. 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial. Lancet. 2006;368:1239–1247
  81. Naylor AR. Where next after SPACE and EVA-3s: ‘the good, the bad and the ugly!’. Eur J Vasc Endovasc Surg. 2007;33:44–47
  82. Rothwell PM, Eliasziw M, Gutnikov SA, Fox AJ, Taylor DW, Mayberg MR, et al. Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet. 2003;361:107–116
  83. Mayberg MR, Wilson SE, Yatsu F, Weiss DG, Messina L, Hershey LA, et al. Carotid endarterectomy and prevention of cerebral ischemia in symptomatic carotid stenosis. Veterans Affairs Cooperative Studies Program 309 Trialist Group JAMA. 1991;266:3289–3294
  84. North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991;325:445–453
  85. Coward LJ, Featherstone RL, Brown MM. Safety and efficacy of endovascular treatment of carotid artery stenosis compared with carotid endarterectomy: a Cochrane systematic review of the randomized evidence. Stroke. 2005;36:905–911
  86. Rothwell PM, Slattery J, Warlow CP. A systematic comparison of the risks of stroke and death due to carotid endarterectomy for symptomatic and asymptomatic stenosis. Stroke. 1996;27:266–269
  87. Role of carotid endarterectomy in asymptomatic carotid stenosis. A Veterans Administration Cooperative Study. Stroke. 1986;17:534–539
  88. Goldstein LB, Samsa GP, Matchar DB, Oddone EZ. Multicenter review of preoperative risk factors for endarterectomy for asymptomatic carotid artery stenosis. Stroke. 1998;29:750–753
  89. Baker WH, Howard VJ, Howard G, Toole JF. Effect of contralateral occlusion on long-term efficacy of endarterectomy in the asymptomatic carotid atherosclerosis study (ACAS). ACAS investigators Stroke. 2000;31:2330–2334
  90. Rothwell PM, Slattery J, Warlow CP. Clinical and angiographic predictors of stroke and death from carotid endarterectomy: systematic review. BMJ. 1997;315:1571–1577
  91. Miller MT, Comerota AJ, Tzilinis A, Daoud Y, Hammerling J. Carotid endarterectomy in octogenarians: does increased age indicate “High risk?”. J Vasc Surg. 2005;41:231–237
  92. Bond R, Rerkasem K, Cuffe R, Rothwell PM. A systematic review of the associations between age and sex and the operative risks of carotid endarterectomy. Cerebrovasc Dis. 2005;20:69–77
  93. Veith FJ, Amor M, Ohki T, Beebe HG, Bell PR, Bolia A, et al. Current status of carotid bifurcation angioplasty and stenting based on a consensus of opinion leaders. J Vasc Surg. 2001;33:S111–S116
  94. Messe SR, Kasner SE, Mehta Z, Warlow CP, Rothwell PM. Effect of body size on operative risk of carotid endarterectomy. J Neurol Neurosurg Psychiatr. 2004;75:1759–1761
  95. Kucey DS, Bowyer B, Iron K, Austin P, Anderson G, Tu JV. Determinants of outcome after carotid endarterectomy. J Vasc Surg. 1998;28:1051–1058
  96. Hertzer NR, O'Hara PJ, Mascha EJ, Krajewski LP, Sullivan TM, Beven EG. Early outcome assessment for 2228 consecutive carotid endarterectomy procedures: the Cleveland Clinic experience from 1989 to 1995. J Vasc Surg. 1997;26:1–10
  97. Wong JH, Findlay JM, Suarez-Almazor ME. Regional performance of carotid endarterectomy. Appropriateness, outcomes, and risk factors for complications. Stroke. 1997;28:891–898
  98. Biasi GM, Froio A, Diethrich EB, Deleo G, Galimberti S, Mingazzini P, et al. Carotid plaque echolucency increases the risk of stroke in carotid stenting: the imaging in carotid angioplasty and risk of stroke (ICAROS) Study. Circulation. 2004;110:756–762
  99. Moore WS, Vescera CL, Robertson JT, Baker WH, Howard VJ, Toole JF. Selection process for surgeons in the Asymptomatic Carotid Atherosclerosis Study. Stroke. 1991;22:1353–1357
  100. Halliday AW, Thomas D, Mansfield A. The Asymptomatic Carotid Surgery Trial (ACST). Rationale and design. Steering Committee. Eur J Vasc Surg. 1994;8:703–710
  101. Rubin JR, Pitluk HC, King TA, Hutton M, Kieger EF, Plecha FR, et al. Carotid endarterectomy in a metropolitan community: the early results after 8535 operations. J Vasc Surg. 1988;7:256–260
  102. Kantonen I, Lepantalo M, Salenius JP, Matzke S, Luther M, Ylonen K. Influence of surgical experience on the results of carotid surgery. The Finnvasc Study Group. Eur J Vasc Endovasc Surg. 1998;15:155–160
  103. Karp HR, Flanders WD, Shipp CC, Taylor B, Martin D. Carotid endarterectomy among Medicare beneficiaries: a statewide evaluation of appropriateness and outcome. Stroke. 1998;29:46–52
  104. Cebul RD, Snow RJ, Pine R, Hertzer NR, Norris DG. Indications, outcomes and provider volumes for carotid endarterectomy. JAMA. 1998;279:1282–1287
  105. Hsia DC, Moscoe LM, Krushat WM. Epidemiology of carotid endarterectomy among Medicare beneficiaries: 1985–1996 update. Stroke. 1998;29:346–350
  106. Hannan EL, Popp AJ, Tranmer B, Fuestel P, Waldman J, Shah D. Relationship between provider volume and mortality for carotid endarterectomies in New York State. Stroke. 1998;29:2292–2297
  107. Mayo Asymptomatic Carotid Endarectomy Study Group . Results of a randomized controlled trial of carotid endarterectomy for asymptomatic carotid stenosis. Mayo Clin Proc. 1992;67:513–518
  108. Lindblad B, Persson NH, Takolander R, Bergqvist D. Does low-dose acetylsalicylic acid prevent stroke after carotid surgery? A double-blind, placebo-controlled randomized trial. Stroke. 1993;24:1125–1128
  109. Rothwell P, Warlow C. Is self-audit reliable?. Lancet. 1995;346:1623
  110. Theiss W, Hermanek P, Mathias K, Ahmadi R, Heuser L, Hoffmann FJ, et al. Pro-cas: a prospective registry of carotid angioplasty and stenting. Stroke. 2004;35:2134–2139
  111. Sacco RL. The 2006 William Feinberg Lecture: shifting the paradigm from stroke to global vascular risk estimation. Stroke. 2007;38:1980–1987
  112. Chaturvedi S. Should the multicenter carotid endarterectomy trials be repeated?. Arch Neurol. 2003;60:774–775
  113. Gorelick PB. Stroke prevention. Arch Neurol. 1995;52:347–355
  114. Spence JD. Intensive management of risk factors for accelerated atherosclerosis: The role of multiple interventions. Curr Neurol Neurosci Rep. 2007;7:42–48

PII: S1078-5884(08)00061-0

doi: 10.1016/j.ejvs.2008.01.017

European Journal of Vascular & Endovascular Surgery
Volume 35, Issue 5 , Pages 524-533 , May 2008

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