BACKGROUND: Our objective was to assess the risks and benefits of carotid endarterectomy, primarily in terms of @entity64 prevention, in @entity1 with recently symptomatic @entity543 . METHODS: This multicentre, randomised controlled trial enrolled 3024 @entity1 . We enrolled @entity1 and @entity1 of any age, with some degree of @entity543 , who within the previous 6 months had had at least one transient or mild symptomatic ischaemic vascular event in the distribution of one or both carotid arteries. Between 1981 and 1994, we allocated 1811 (60%) @entity1 to surgery and 1213 (40%) to control (surgery to be avoided for as long as possible). Follow-up was until the end of 1995 (mean 6.1 years), and the main analyses were by intention to treat. FINDINGS: The overall outcome ( @entity64 or @entity204 ) occurred in 669 (37.0%) surgery-group @entity1 and 442 (36.5%) control-group @entity1 . The risk of @entity64 or @entity204 complicating surgery (7.0%) did not vary substantially with severity of @entity850 . On the other hand, the risk of major @entity64 ipsilateral to the unoperated symptomatic carotid artery increased with severity of @entity850 , particularly above about 70-80% of the original luminal diameter, but only for 2-3 years after randomisation. On average, the immediate risk of surgery was worth trading off against the long-term risk of @entity64 without surgery when the @entity850 was greater than about 80% diameter; the Kaplan-Meier estimate of the frequency of a @entity64 or @entity204 at 3 years was 26.5% for the control group and 14.9% for the surgery group, an absolute benefit from surgery of 11.6%. However, consideration of variations in risk with age and sex modified this simple rule based on @entity850 severity. We present a graphical procedure that should improve the selection of @entity1 for surgery. INTERPRETATION: Carotid endarterectomy is indicated for most @entity1 with a recent non-disabling carotid-territory ischaemic event when the symptomatic @entity850 is greater than about 80%. Age and sex should also be taken into account in decisions on whether to operate.

Randomised trial of endarterectomy for recently symptomatic XXXX : final results of the MRC European Carotid Surgery Trial (ECST)

@entity1 :: ('9606', 'Species') :: ['women', 'patients', 'men'] @entity64 :: ('MESH:D020521', 'Disease') :: ['stroke', 'ischaemic stroke', 'major stroke'] @entity850 :: ('MESH:D003251', 'Disease') :: ['stenosis'] @entity204 :: ('MESH:D003643', 'Disease') :: ['death'] @entity543 :: ('MESH:D016893', 'Disease') :: ['carotid stenosis']
@entity543 :: (MESH:D016893,Disease) :: ['carotid stenosis']
