need name of study on carotid artery stenosis surgery

Not looking for medical advice; I just need the name of a publication.

My dad has been diagnosed with a 70%-occluded carotid artery, and his doctor is recommending surgery to correct it.

We’d like to make an informed decision.

My mom has mentioned a study a few years back in which an experimental group of patients had the surgery, and a control group did not. The study was supposed to last a couple of years, but after just six months they were ethically compelled to halt the study and give everyone in the control group the surgery because it had been shown to be so amazingly successful.

Can anyone point to the name of the study? I have pubmed access, but there are too many studies coming up in the search results; I’m not sure what to look for. I’d like to review the descriptions of the patients involved, and see how my dad’s own circumstances compare with them.

Try these, also look for articles in JAMA and The Lancet

http://en.wikipedia.org/wiki/Carotid_artery_stenosis#References

Try the above line, duh-oh.

Thanks for the info. I misunderstood my mom; I was under the impression that this was a recent study, and that there wouldn’t be a lot of new info out there. Turns out they’ve been doing endarterectomies for decades, and the study she was referring to is very old, so there’s tons of info out there.

You’re talking about the NASCET trial (North American Symptomatic Carotid Endarterctomy Trial). It was the game changer (1991).

Look here.

Thanks, that was extremely informative. The benefits of endarterectomy seem clear from that paper; indeed, it was clear enough for them to stop putting high-risk patients in the control group before the study was over and just give all of them the surgery.

My wife has since tracked down this paper that compares stenting with the endarterectomy described in the NASCET paper, but it only talks about the 30-day risk of stroke/death, whereas the NASCET paper monitored patients for two years after the surgery. Can you recommend a paper that shows stenting outcomes over a similar time frame?

My pleasure.

Here’s a recent meta-analysis (sorry, no free full text on that one). And, here is a key 2010 trial in the area (full free text from the New England Journal)

Thanks again. :slight_smile: My wife should be able to obtain the full text of the first article.

I actually tried to get it (and was then going to ask if you wanted me to e-mail it to you). Alas, since it is only e-published as of now (an early release), it is one that I can’t (seem to) get via my University’s on-line library. Frustrating!

Hmm…maybe my wife won’t be able to get it either, then…:frowning:

download.journals.elsevierhealth.com/pdfs/journals/0890-5096/PIIS0890509612000386.pdf

Assuming that’s not due to a cookie I’m not aware of, that should be available to anyone. I would also say that the endovascular specialists I know feel pretty strongly that CAS is highly operator dependent and that their results are superior to the numbers from the large trials out there. Then again, every surgeon thinks that about pretty much every procedure they do…