The North American Symptomatic Carotid Endarterectomy Trial (NASCET)

One discussion this week involved the North American Symptomatic Carotid Endarterectomy Trial (NASCET).

Reference: Barnett HJM, et al. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosisNew England Journal of Medicine. 1998 Nov 12;339(20):1415-1425.

Summary: NASCET involved 2226 patients with stenosis of less than 70 percent. They were randomly assigned to treatment groups: 1118 to medical therapy, 1108 to surgical therapy (p.1417).

Four patient characteristics are associated with greater benefit from surgery: male sex, recent stroke, recent hemispheric symptoms, and taking 650 mg or more of aspirin per day (p.1419).

NASCET authors explain that the lack of significant benefit for women may be due to their low risk of stroke. Among participants with 50-69% stenosis, the risk of any ipsilateral stroke at 5 years in the medically treated group was 15% for women, and 25% for men. Endarterectomy reduced the risk to 14% for women and 17% for men (p. 1421).

The table below shows the rate of events at 5-year followup:

table5

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