Modern medical treatment with or without carotid endarterectomy for severe asymptomatic carotid atherosclerosis

Kolos, I.; Troitskiy, A.; Balakhonova, T.; Shariya, M.; Skrypnik, D.; Tvorogova, T.; Deev, A.; Boytsov, S.; Akezheva, L.R.; Dupik, N.V.; Ershova, A.I.; Fedotenkov, I.S.; Fyodorova, V.I.; Khabazov, R.I.; Loukianov, M.M.; Nikonova, M.; Shevchenko, N.A.; Stepanyants, E.Y.; Strazden, E.Y.; Tripoten, M.I.; Ust’Yantseva, N.V.; for Asymptomatic Carotid Artery Stenosis (AMTEC) Study Group Aggressive Medical, T.E.

Авторы: Kolos I., Troitskiy A., Balakhonova T., Shariya M., Skrypnik D., Tvorogova T., Deev A., Boytsov S., Akezheva L.R., Dupik N.V., Ershova A.I., Fedotenkov I.S., Fyodorova V.I., Khabazov R.I., Loukianov M.M., Nikonova M., Shevchenko N.A., Stepanyants E.Y., Strazden E.Y., Tripoten M.I., Ust’Yantseva N.V., for Asymptomatic Carotid Artery Stenosis (AMTEC) Study Group Aggressive Medical Treatment Evaluation
Журнал: Journal of Vascular Surgery
Том: 62
Номер: 4
Год издания: 2015
Издательство: Mosby Inc.
Местоположение издательства: United States
Первая страница: 914
Последняя страница: 922
DOI: 10.1016/j.jvs.2015.05.005
Аннотация: Objective This study assessed the value of modern medical treatment (MMT) with and without carotid endarterectomy (CEA) in patients with asymptomatic severe carotid artery stenosis. Methods We conducted a randomized trial involving 55 patients with 70% to 79% carotid stenosis at three Russian centers. Between 2009 and 2013, 31 patients were randomized to undergo CEA with MMT (CEA group) and 24 to receive MMT alone. The primary end point was nonfatal ipsilateral stroke or death from any cause during a follow-up period of 5.0 years. The secondary end point was any nonfatal stroke, carotid revascularization, or death from any cause during follow-up. Results The trial was stopped after a median follow-up of 3.3 years (maximum, 5.0 years). There were two primary events in the CEA group and nine events in the MMT group. The 3.3-year cumulative primary event rates were 6.5% in the CEA group and 37.5% in the MMT group (hazard ratio for the MMT group, 5.06; 95% confidence interval, 1.53-16.79; P =.008). The 3.3-year cumulative secondary end point was 12.9% in the CEA group and 50.0% in the MMT group (hazard ratio for the MMT group, 4.23; 95% confidence interval, 1.55-11.53; P =.0048). Conclusions CEA as an initial management strategy could reduce the risk of death and major cerebrovascular events when added to MMT. В© 2015 Society for Vascular Surgery.
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Modern medical treatment with or without carotid endarterectomy for severe asymptomatic carotid atherosclerosisстатья