1118 patients were allocated to medical care, and 1108 patients were allocated to surgical care. Any stroke ipsilateral to the stenosis studied in each patient. Main results Analysis was by intention to treat. Subgroups with different long-term benefits from surgery were defined by several factors, including the characteristics of the qualifying event, the dose of prophylactic aspirin, and the sex of the patient. The difference may relate to women being less likely to have an ipsilateral stroke and more likely to have complications from angiography and surgery than men.
Many issues remain.
The degree of stenosis and symptoms may not be enough to identify diseased carotid arteries that carry the greatest risk for subsequent ipsilateral stroke. In this trial, three quarters of patients treated medically did not have a subsequent ipsilateral stroke. Finally, we need to develop less risky, more effective, and less costly approaches than those that are currently used for stenoses identified as being the most dangerous. Will Longstreth, MD University of Washington Seattle, Washington, USA Reference 1.