Original Article
Beneficial Effect of Carotid Endarterectomy in Symptomatic Patients with High-Grade Carotid Stenosis
N Engl J Med 1991; 325:445-453August 15, 1991
- Abstract
- Abstract
Background.
Without strong evidence of benefit, the use of carotid endarterectomy for prophylaxis against stroke rose dramatically until the mid-1980s, then declined. Our investigation sought to determine whether carotid endarterectomy reduces the risk of stroke among patients with a recent adverse cerebrovascular event and ipsilateral carotid stenosis.
Methods.
We conducted a randomized trial at 50 clinical centers throughout the United States and Canada, in patients in two predetermined strata based on the severity of carotid stenosis—30 to 69 percent and 70 to 99 percent. We report here the results in the 659 patients in the latter stratum, who had had a hemispheric or retinal transient ischemic attack or a nondisabling stroke within the 120 days before entry and had stenosis of 70 to 99 percent in the symptomatic carotid artery. All patients received optimal medical care, including antiplatelet therapy. Those assigned to surgical treatment underwent carotid endarterectomy performed by neurosurgeons or vascular surgeons. All patients were examined by neurologists 1, 3, 6, 9, and 12 months after entry and then every 4 months. End points were assessed by blinded, independent case review. No patient was lost to follow-up.
Results.
Life-table estimates of the cumulative risk of any ipsilateral stroke at two years were 26 percent in the 331 medical patients and 9 percent in the 328 surgical patients—an absolute risk reduction (±SE) of 17±3.5 percent (P<0.001). For a major or fatal ipsilateral stroke, the corresponding estimates were 13.1 percent and 2.5 percent — an absolute risk reduction of 10.6±2.6 percent (P<0.001 ). Carotid endarterectomy was still found to be beneficial when all strokes and deaths were included in the analysis (P<0.001).
Conclusions.
Carotid endarterectomy is highly beneficial to patients with recent hemispheric and retinal transient ischemic attacks or nondisabling strokes and ipsilateral high-grade stenosis (70 to 99 percent) of the internal carotid artery. (N Engl J Med 1991; 325:445–53.)
Media in This Article
Figure 1
Survival Curves for the Treatment Groups.Table 1
Base-Line Characteristics of the Treatment Groups.Article Activity
- Article
CAROTID endarterectomy was introduced in 1954 as a logical procedure for the prevention of ischemic stroke distal to carotid-artery stenosis.1 Although the first randomized trials of its effectiveness had negative results,2 3 4 surgeons continued to perform carotid endarterectomy and began to report lower rates of perioperative complications.5 , 6
The number of patients undergoing endarterectomy in hospitals in the United States (other than Veterans Affairs hospitals) rose from 15,000 in 1971 to 107,000 in 1985.7 However, continuing uncertainty about the efficacy of the operation was reflected in marked geographic variation in the rates of endarterectomy.8 Adding to this uncertainty was the decline in the number of first and fatal strokes,9 10 11 the influence of risk-factor management in reducing strokes,12 13 14 and emerging recognition of the efficacy of antiplate-let drugs in preventing stroke.15 When a randomized trial demonstrated that extracranial—intracranial bypass was ineffective in preventing stroke,16 this presented an opportunity to reexamine the current efficacy of carotid endarterectomy as performed in North America, and several randomized trials were begun in both symptomatic and asymptomatic patients,17 complementing the European Carotid Surgery Trial already under way.18 This report describes the first definitive results of this new round of trials of carotid endarterectomy.
Methods
A full description of the methods of the study has been published elsewhere.19 The key features of the conduct of the trial were as follows.
Center Eligibility
The study was conducted at 50 centers in the United States and Canada. Each center had a rate of less than 6 percent for stroke and death occurring within 30 days of operation for at least 50 consecutive carotid endarterectomies performed within the previous 24 months, and each had obtained approval of the research protocol from its local institutional review board.
Patient Eligibility
To be eligible for the trial, patients had to give informed consent, be less than 80 years old, and have had a hemispheric transient ischemic attack (distinct focal neurologic dysfunction) or monocular blindness persisting less than 24 hours or a nondisabling stroke with persistence of symptoms or signs for more than 24 hours within the previous 120 days, in association with stenosis of 30 to 99 percent in the ipsilateral internal carotid artery; the artery had to be technically suitable for endarterectomy, as assessed by selective carotid angiography.
Using a jeweler's eyepiece marked in tenths of a millimeter, the principal neuroradiologist measured on the angiograms of each patient the luminal diameter (on two views) at the point of greatest stenosis and at the normal part of the artery beyond the carotid bulb. The percent stenosis was determined by calculating the ratio of these two measurements, with use of the view showing the greatest degree of narrowing. If review by the Data Management Center (Robarts Institute) found the stenosis to be less than 30 percent, the angiograms were submitted for independent external adjudication. Patients were categorized at entry as being in one of two predetermined strata: those with 30 to 69 percent stenosis and those with 70 to 99 percent stenosis. The reliability of this assignment was checked in a blinded fashion by the principal neuroradiologist in 127 randomly selected patients; this check revealed a high degree of consistency (kappa = 0.89).
Patients were excluded from the study if they (1) were mentally incompetent or unwilling to give informed consent; (2) had no angiographic visualization of both carotid arteries and their intracranial branches; (3) had an intracranial lesion that was more severe than the surgically accessible lesion; (4) had organ failure of the kidney, liver, or lung, or had cancer judged likely to cause death within five years; (5) had a cerebral infarction on either side that deprived the patient of all useful function in the affected territory; (6) had symptoms that could be attributed to nonatherosclerotic disease (e.g., fibromuscular dysplasia, aneurysm, or tumor); (7) had a cardiac valvular or rhythm disorder likely to be associated with cardioembolic symptoms; or (8) had previously undergone an ipsilateral carotid endarterectomy.
Patients were temporarily ineligible if they had uncontrolled hypertension, diabetes mellitus, or unstable angina pectoris; myocardial infarction within the previous 6 months; signs of progressive neurologic dysfunction; contralateral carotid endarterectomy within the previous 4 months; or a major surgical procedure within the previous 30 days. Such patients could become eligible if the disorder causing their temporary ineligibility resolved within 120 days after their qualifying cerebrovascular event. The data on all ineligible patients and all who were eligible but did not undergo randomization, including all patients undergoing carotid endarterectomy outside the trial, were reported to the Nonrandomized Data Center at the Mayo Clinic.19
Base-Line Investigations
Patients underwent standardized history taking, physical and neurologic examinations, a 12-point assessment of functional status, laboratory tests, 12-lead electrocardiography, computerized tomography of the head, angiography and duplex ultrasonography of the carotid arteries, and chest roentgenography.
Randomization
On transmission of base-line data to the Data Management Center, patients were randomly assigned to receive either medical care alone or medical care plus surgery, according to a computer-generated randomization schedule.
Treatment
Antiplatelet treatment (usually 1300 mg of aspirin per day or a lower dose if necessitated by side effects) and, as indicated, antihypertensive, antilipid, and antidiabetic therapy was prescribed for all patients. Those assigned to surgery also underwent carotid endarterectomy. The surgical technique was left to the discretion of the surgeon, and the procedures have been described elsewhere.19 Simultaneous coronary-artery bypass grafting and simultaneous bilateral carotid endarterectomy were proscribed. Patients with bilateral stenosis who were assigned to surgery could undergo bilateral endarterectomy if the symptomatic side of the carotid was operated on first.
Follow-up
Study surgeons completed postoperative assessments 30 days after surgery or at the time of hospital discharge, whichever occurred first. Study neurologists performed medical, neurologic, and functional-status assessments of all patients one month after entry, then every three months for the first year, and every four months thereafter. The management of cardiovascular risk factors was monitored centrally, and reminders were sent to neurologists if necessary. Computed tomography of the head was performed if cerebrovascular events were suspected. Duplex ultrasonography was repeated one month after entry and after any cerebrovascular event in the carotid distribution. Carotid angiography was repeated after any cerebrovascular event when considered clinically appropriate.
Events
All deaths were assessed for their immediate, underlying, and contributing causes. Strokes were assessed for location, type, laterality, severity, and duration, according to the definitions published by the Committee on Classification of Cerebrovascular Disease of the National Institute of Neurological Disorders and Stroke.20 New lesions identified on computed tomography were not considered strokes unless appropriate signs or symptoms persisted beyond 24 hours.
Patient eligibility and events were assessed at three levels: by the participating neurologist and surgeon at each center, by the steering committee at the Data Management Center (where a staff neurologist tracked down missing or additional data as needed and then presented each case without revealing treatment assignment), and by a team of blinded external adjudicators who were not otherwise involved in the trial.
Statistical Analysis
The original calculations of sample size allowed for independent analyses in each of four angiographic subgroups defined by the degree of stenosis and angiographic evidence of ulceration. However, the comparison of base-line angiograms and surgical specimens confirmed the insensitivity of angiography in detecting ulceration.21 Accordingly, this stratification was removed from the primary analyses, leaving just the two strata of high-grade (severe) stenosis (70 to 99 percent) and medium-grade (moderate) stenosis (30 to 69 percent).
All analyses compared medical and surgical patients with respect to the length of time before treatment failure by means of the MantelHaenszel chi-square test and Kaplan–Meier survival curves. All reported P values are two-tailed. The primary analysis defined treatment failure as any fatal or nonfatal stroke ipsilateral to the carotid lesion. Other definitions included all strokes and all deaths as well as consideration of the severity of stroke. Strokes producing functional deficits persisting beyond 90 days were considered major. Each of these analyses included all strokes (regardless of location) and all deaths (regardless of cause) that occurred among surgical patients during the 30-day postoperative period and among medical patients during a comparable period after randomization.
Patients found to be ineligible because they did not have either an appropriate carotid lesion or corresponding symptoms were excluded from the primary analysis. Patients who were crossed over to the other treatment group were included in the primary analysis up to the date of crossover, but not after that date.
As dictated in the protocol, monthly interim analyses were initiated in January 1990 (two years after the randomization of the first patient). If the results of any of these monthly analyses, known only to the principal biostatistical investigator and a clinical epidemiologist, showed a difference between the medical and surgical groups that had reached a level of statistical significance of 0.1 percent (P<0.001), the chairman of the National Institutes of Health monitoring committee was to be notified. If this difference remained at the 0.1 percent level over a six-month period, and if the supporting analyses indicated that the interpretation of these results was unambiguous and clinically important, the full monitoring committee was to be convened. The committee was also to be convened if it became possible to rule out, with a high level of confidence, a 10 percent reduction in relative risk as a result of carotid endarterectomy.
Analyses were conducted to ascertain the importance of risk factors by dividing patients into three risk groups of approximately equal size according to a simple count of the commonly recognized risk factors with the use of arbitrary cutoff points: age (>70 years), sex (male), systolic blood pressure (>160 mm Hg), diastolic blood pressure (>90 mm Hg), recency (<31 days) and type of prior cerebrovascular events (stroke, not transient ischemic attack), degree of stenosis (>80 percent), presence of ulceration on the angiogram, and a history of smoking, hypertension, myocardial infarction, congestive heart failure, diabetes, intermittent claudication, or high blood lipid levels. These risk factors and cutoff points were chosen in advance and were not derived through analysis of the data.
Results
Early Termination of the Study in Patients with High-Grade Stenosis
On February 1, 1991, the trial's preplanned rule for stopping randomization was invoked because of evidence of treatment efficacy among patients with high-grade stenosis (70 to 99 percent) who underwent carotid endarterectomy. On February 21, the monitoring and executive committees agreed that (1) randomization of patients with high-grade stenosis should be stopped, (2) a summary of the results in the patients with high-grade stenosis should be communicated immediately to the participating clinicians, along with a list of all patients given medical treatment alone to whom the results might apply, (3) reports of all strokes and deaths and all patient assessments occurring before February 21 should be collected as quickly as possible for inclusion in this report, and (4) the parallel study dealing with symptomatic patients with medium-grade stenosis (30 to 69 percent) should be continued. The sponsoring agency, the National Institute of Neurological Disorders and Stroke, independently issued a peer-reviewed Clinical Alert to convey immediately a summary of these interim results to physicians across North America.
Patient Entry
Six hundred sixty-two patients with high-grade carotid stenosis (determined by central radiologic review) were enrolled between January 1, 1988, and February 21, 1991. Of these, three patients (0.5 percent) were subsequently excluded from the primary analysis by a blinded review panel because they did not meet entry criteria: one (assigned to surgical treatment) had symptoms due solely to glaucoma, one (assigned to medical therapy) had symptoms of a vertebrobasilar transient ischemic attack only, and one (assigned to surgical treatment) had occlusion of the internal carotid artery. Randomization created balanced treatment groups with respect to the qualifying cerebrovascular events, underlying vascular lesions, and important prognostic characteristics (Table 1Table 1
Base-Line Characteristics of the Treatment Groups.). The similarity between the patients included and those excluded, reported elsewhere,19 confirmed that no subgroup of eligible patients was systematically excluded from the trial.Patient Follow-up
No patient was lost to follow-up and none withdrew; 98 percent of the surviving patients had their last follow-up examination within 4 months of the February 21 closing date, and the average duration of follow-up was 18 months. Twenty-one medical patients (6.3 percent) were crossed over and underwent carotid endarterectomy on the same side as the lesion for which they were randomized (10 after transient ischemic attacks, 6 after a stroke, 2 as a prelude to other required surgery, 2 after refusing the random assignment, and 1 on the advice of a nonparticipating physician). Of the 328 patients assigned to surgery, only 1 refused the operation and received medical treatment alone. All the others underwent carotid endarterectomy, performed an average of two days after randomization. Medical regimens to reduce the risk of stroke were applied equally in both treatment groups. At the last reported follow-up examination, antihypertensive therapy was being given to 187 medical patients (57 percent) and 178 surgical patients (54 percent); elevation of the diastolic blood pressure (>95 mm Hg) was significantly more prevalent among the surgical patients than the medical patients (13 percent vs. 8 percent, P<0.05). Over 99 percent of both medical and surgical patients were taking anti-thrombotic drugs at the last follow-up visit, most commonly aspirin, which was being used by 94 percent of the medical patients and 98 percent of the surgical patients.
Perioperative Morbidity and Mortality
The perioperative period was considered the time from randomization to 30 days after surgery (which was performed a median of 2 days after randomization). None of the 328 surgical patients had a stroke or died between randomization and surgery. In the perioperative period, 18 surgical patients (5.5 percent) had cerebrovascular events; 12 events were minor, 5 were major (i.e., causing a functional deficit persisting ≥90 days), and 1 was fatal. In addition, one patient died suddenly after surgery, for a rate of 5.8 percent for all perioperative stroke and death. Restricting the analysis to the most serious events resulted in a rate of 2.1 percent for major stroke and death and a fatality rate of 0.6 percent.
In the comparable 32-day period after randomization among the 331 medical patients, 11 (3.3 percent) had cerebrovascular events; 8 events were minor, 2 were major, and 1 was fatal. This resulted in a rate of 3.3 percent for all stroke and death within 32 days of randomization, which included a rate of 0.9 percent for major stroke and death and a fatality rate of 0.3 percent.
Other surgical complications included cranialnerve injury (7.6 percent), wound hematoma (5.5 percent), wound infection (3.4 percent), myocardial infarction (0.9 percent), congestive heart failure (0.6 percent), arrhythmia (1.2 percent), and other cardiovascular problems (1.2 percent). Of these complications, 81 percent were considered mild (of no lasting consequence and not prolonging hospitalization) and the rest were considered moderate (of no lasting consequence but prolonging the hospital stay).
Events
As shown in the first row of Table 2Table 2
First Adverse Events and Actuarial Failure Rates at Two Years of Follow-up, According to the Event Defining Treatment Failure., the life-table estimate of the risk of any fatal or nonfatal ipsilateral stroke by 24 months after randomization was 26 percent for the medical patients and only 9 percent for the surgical patients (including any stroke or death occurring postoperatively or within 32 days of randomization), resulting in an absolute risk reduction of 17 percent. Thus, for every 100 patients treated surgically, 17 were spared an ipsilateral stroke over the next two years. This represents a relative-risk reduction of 65 percent and shows that six such patients are the "number needed to be treated"22 in order to prevent one adverse event by 24 months. The second through sixth rows of Table 2 show that carotid endarterectomy remained beneficial with respect to each of the five other definitions of outcome events.The vast majority of first events were ipsilateral strokes (61 in medical patients vs. 26 in surgical patients), and although the overall difference between the treatment groups remained significant when other events were included, carotid endarterectomy proved beneficial in that it reduced ipsilateral strokes. The inclusion of stroke in the distribution of the contralateral carotid and vertebral basilar arteries added only three events to those in the medical group and eight to those in the surgical group, and the further addition of death from any cause added another nine and seven events, respectively. The treatment groups did not differ significantly in total mortality (Table 3Table 3
Total Mortality According to Treatment Group.).Survival curves for the values reflected in each of the rows in Table 2 are shown in Figure 1Figure 1
Survival Curves for the Treatment Groups.. They reveal two additional points of interest. First, the early disadvantage to the surgical patients (who faced a risk of perioperative stroke and death) was rapidly overcome, with the curves for the medical and the surgical patients crossing about three months after randomization. Second, there was no evidence of convergence of the two curves for as long as 30 months, indicating that the beneficial effects of surgery persisted at least this long.Among the patients who did not die or have a major stroke during the first month after randomization, the risk of any major or fatal stroke within two years was 12.2 percent in the medical group and 1.6 percent in the surgical group (P<0.00001). Thus, the immediate postoperative increase in the risk of major stroke or death among the surgical patients, 1.2 percent (2.1 percent — 0.9 percent), was offset by an absolute risk reduction of 10.6 percent for major or fatal stroke during the subsequent two years.
Analyzing our results according to the intention-to-treat principle produced essentially the same levels of significance and standard errors for between-group differences. This analysis, which included the three incorrectly randomized ineligible patients and counted events occurring in a patient after crossover according to the group to which the patient had originally been assigned, added just one event to those in the medical group and two events to those in the surgical group. The analyses reported in this paper include 30 patients found to be technically ineligible because of inadequate angiography (17 patients), severe intracranial stenosis (4), cerebral aneurysms (3), cardiac disorders (3), and other medical problems (3). Excluding these patients from the analysis reduced by five the events in the medical group and by three the events in the surgical group and did not alter the interpretation of the results. An analysis comparing results at large centers with those at small centers, and results at U.S. centers with those at Canadian centers, revealed no significant differences in the benefit of surgery according to the size or country of a study center.
The proportion of medical patients who had an ipsilateral stroke within two years was 17 percent in the low-risk group (0 to 5 risk factors), 23 percent in the moderate-risk group (6 risk factors), and 39 percent in the high-risk group (≥7 risk factors) (P<0.001). The prognosis of the surgical patients did not vary significantly among risk groups and averaged 9 percent at two years.
A secondary analysis showed that finer divisions of the degree of high-grade carotid stenosis (i.e., 70 to 79, 80 to 89, and 90 to 99 percent) correlated with the degrees of risk reduction after surgery. The absolute risk reduction (±SE) for all ipsilateral stroke at two years was 26±8.1 percent among patients with stenosis of 90 to 99 percent at entry, 18±6.2 percent among those with stenosis of 80 to 89 percent, and 12±4.8 percent among those with stenosis of 70 to 79 percent.
Discussion
Among symptomatic patients with high-grade stenosis (70 to 99 percent), those who underwent carotid endarterectomy had an absolute reduction of 17 percent in the risk of ipsilateral stroke at two years (P<0.001). This benefit was not diminished when strokes in other carotid and vertebral basilar territories and deaths from all causes were included in the analysis. Furthermore, clinically important and statistically significant beneficial effects persisted when the analyses excluded minor and nondisabling strokes and when they included patients with protocol violations.
Similar results have recently been reported from the European Carotid Surgery Trial.18 Among 778 symptomatic patients with severe stenosis (70 to 99 percent) who were randomly assigned to treatment with carotid endarterectomy or medical care alone, 7.5 percent of the surgical patients had an ipsilateral stroke or died within 30 days of surgery. Life-table estimates of the risk of ipsilateral stroke during the next three years yielded an additional risk of 2.8 percent for surgical patients, as compared with 16.8 percent for medical patients (P<0.0001). The European study also concluded that the immediate risks of surgery outweighed any potential long-term benefit in the 374 symptomatic patients with mild stenosis (0 to 29 percent). Because definitive conclusions are not yet possible, both the European and North American trials are being continued in patients with moderate stenosis (30 to 69 percent).
After surgery, we observed no significant difference in event rates among patients with different numbers of base-line risk factors. Thus, the degree of benefit that individual patients received from carotid endarterectomy was directly proportional to the risk they faced without surgery, and those with the highest risk at entry gained the most. Our original estimates of the risk of stroke (4 to 7 percent per year), based on results in placebo groups in trials of antithrombotic drugs, substantially underestimated the risk of stroke among symptomatic patients with high-grade stenosis. The life-table estimates of the risk of stroke at two years among our medical patients were 26 percent for ipsilateral stroke, 28 percent for stroke in any territory, and 32 percent for any stroke or death.
We caution readers not to apply our conclusions too broadly. First, the study surgeons were selected only after audits of their endarterectomy results by our surgical committee confirmed a high level of expertise. If comparable expertise and quality control are not achieved in the widespread implementation of these results and the perioperative risk of major stroke and death exceeds the 2.1 percent reported here, the benefit of endarterectomy will diminish. If the rate of major complications approaches 10 percent, the benefit will vanish entirely. Second, our method of measuring stenosis was strict. The results reported here relate only to patients in whom the ratio of the narrowest diameter of the diseased artery (the numerator) to the diameter of the artery beyond the bulb and beyond recognizable disease involvement (the denominator) indicated stenosis of 70 to 99 percent. Our results do not apply if the diameter of the carotid bulb or a segment with poststenotic dilatation is used as the denominator of this ratio in the measurement of stenosis (the severity of stenosis would be overestimated). Third, we have no information about the efficacy of endarterectomy in patients whose ischemic events occur more than 120 days before surgery or who either have already had a devastating stroke or are in the throes of a progressing stroke. Nor did our study include patients who had failure of other major organs or heart disorders that might produce emboli. Also, as indicated by the preponderance of ipsilateral stroke, the patients included in this study did not have widespread cerebrovascular disease.
Patients in both treatment groups underwent cervical and intracranial carotid arteriography before randomization in order to rule out the presence of distal disease more severe than that in the surgically accessible cervical carotid artery. Because a major stroke complicating arteriography would preclude admission to the trial, the benefits reported here should be adjusted downward to include the risk of arteriography. The risk of major stroke or death due to angiography should be no more than 1 percent in patients studied because of arteriosclerotic disease of the cerebral arteries.23 24 25 If the decision to perform angiography were based on the results of noninvasive ultrasound examination, patients with lesser degrees of stenosis could be spared the risks of angiography. A rigorous comparison of ultrasound with angiography in symptomatic patients would be required to give a precise estimate of the effect of this diagnostic strategy.
In our group of patients with high-grade stenosis, those with less severe stenosis had a lower risk of stroke, and their gains from surgery were smaller than those of patients with more severe stenosis. This observation reinforces a continuing uncertainty about the efficacy of carotid endarterectomy for stenosis in the range of 30 to 69 percent. The investigators in both the North American and the European trials are continuing to study symptomatic patients with moderate stenosis (30 to 69 percent). Together these trials will determine whether patients with this degree of stenosis will benefit from endarterectomy, and if so, will identify the point at which the risks of surgery outweigh its benefits.
The effects of publishing the results of both trials on the future frequency of carotid endarterectomy will be followed with considerable interest. Over the past few years, many referring physicians have shown a declining interest in carotid endarterectomy and have acted as if the absence of proof were the proof of absence. In 1985, 107,000 carotid endarterectomies were performed in hospitals (excluding Veterans Affairs hospitals) in the United States. By 1989, the number had diminished to 70,000 (Dyken ML, Pokras R: personal communication). In the light of the results reported here, this reduction in the number of carotid endarterectomies may have deprived some patients with high-grade stenosis of what is now confirmed to be a beneficial operation.
On the basis of these results and those of the European trial, patients with transient ischemic attacks or recent minor strokes without an obvious cardiac cause, who are otherwise fit for surgery, should be screened with noninvasive ultrasonographic techniques. Those with minimal narrowing or none should be treated with what is currently the best medical care. Those with moderate or severe narrowing should be seriously considered for arteriography. If those shown by arteriography to have moderate stenosis (30 to 69 percent) are referred to one of the study centers of the North American trial, the part of the trial focusing on moderate stenosis will be concluded sooner. Patients with high-grade stenosis (70 to 99 percent) should be considered for referral to institutions and surgeons who practice vigorous quality control and have the low rates of perioperative morbidity and mortality that have characterized the centers and physicians in this trial.
These positive findings among symptomatic patients with high-grade stenosis provide no answers to the question of the optimal treatment of patients with asymptomatic carotid stenosis. It is essential that the trials under way to study such patients be continued.
Supported by a grant (R01-NS-24456) from the National Institute of Neurological Disorders and Stroke.
Source Information
* The collaborators in this trial are listed in the Appendix.
Address reprint requests to D.W. Taylor at the Department of Clinical Epidemiology and Biostatistics, McMaster University. 1200 Main St. W., Hamilton, ON L8N 3Z5, Canada, or to Dr. H.J.M. Barnett at the John P. Robarts Research Institute, P.O. Box 5015, 100 Perth Dr., London, ON N6A 5K8, Canada.
Appendix
The following persons and institutions participated in the North American Symptomatic Carotid Endarterectomy Trial:
Steering and Writing Committee of the Executive Committee: Principal Investigator — Henry J.M. Barnett, M.D. (John P. Robarts Research Institute); Co-Principal Investigators — D.W. Taylor, M.A. (biostatistics; Chairman, Writing Committee), R.B. Haynes, M.D. (epidemiology), and D.L. Sackett, M.D. (epidemiology) (McMaster University); S.J. Peerless, M.D. (surgery), G.G. Ferguson, M.D. (surgery), A.J. Fox, M.D. (neuroradiology), R.N. Rankin, M.D. (neurosonography), and V.C. Hachinski, M.D. (neurology) (University of Western Ontario); D.O. Wiebers, M.D. (neurology) (Mayo Clinic); and M. Eliasziw, Ph.D. (biostatistics) (John P. Robarts Research Institute). Additional Members of Executive Committee (current and past): H.W.K. Barr, M.D., G.P. Clagett, M.D., J.D. Easton, M.D., J.W. Harbison, M.D., R.C. Heros, M.D., A.R. Hudson, M.D., J.R. Marler, M.D., R.A. Ratcheson, M.D., D. Sim, Ph.D., D. Simard, M.D., M.D. Walker, M.D., P.M. Walker, M.D., and P.A. Wolf, M.D. Surgical Committee: S.J. Peerless, M.D. (Chairman), G.G. Ferguson, M.D. (Secretary), G.P. Clagett, M.D., R.C. Heros, M.D., A.R. Hudson, M.D., R.H. Patterson, M.D., M. Webster, M.D., R.A. Ratcheson, M.D., and P.M. Walker, M.D.
The participating centers, in order of the number of eligible patients entered, were as follows: University of Western Ontario (University Hospital and St. Joseph's Health Centre), London, Ont.: V.C. Hachinski, M.D. (Principal Investigator), C. Swan, R.N. (Coordinator), C. White, R.N. (Coordinator), G.G. Ferguson, M.D., S.J. Peerless, M.D., and H. Reichman, M.D.; University of Toronto, Toronto: F.L. Silver, M.D. (Principal Investigator), B. Huth (Coordinator), S. Slattery (Coordinator), N.H. Bayer, M.D., D.S. Borrett, M.D., V.M. Campbell, M.D., J.F.R. Fleming, M.D., F. Gentili, M.D., M.A. Keller, M.D., R.J. Moulton, M.D., P.J. Muller, M.D., P.M. Walker, M.D., and M.C. Wallace, M.D.; Virginia Commonwealth University, Richmond: J.W. Harbison, M.D. (Principal Investigator), P. Rosenfeld, R.N. (Coordinator), W.L. Felton III, M.D., H.M. Lee, M.D., J.P. Muizelaar, M.D., M. Sobel, M.D., W. Stringer, M.D., and J.R. Taylor, M.D.; University of British Columbia, Vancouver: V.P. Sweeney, M.D. (Principal Investigator), J.L. Bloomer, R.N. (Coordinator), D. Cameron, M.D., R. Nugent, M.D., J. Reid, M.D., A.J. Salvian, M.D., J.G. Sladen, M.D., and P. Teal, M.D.; University of Western Ontario (Victoria Hospital), London, Ont.: J.D. Spence, M.D. (Principal Investigator), L. Sykes, R.N. (Coordinator), B. Tate, R.N. (Coordinator), H.W.K. Barr, M.D., K. Harris, M.D., and W. Pexman, M.D.; Laval University (Hôpital de l'Enfant-Jesus), Quebec City, Que.: D. Simard, M.D. (Principal Investigator), A. Lajeunesse, R.N. (Coordinator), J.M. Bouchard, M.D., J. Cote, M.D., D. Marois, M.D., C. Roberge, M.D., and J.F. Turcotte, M.D.; University of Ottawa, Ottawa, Ont.: B.G. Benoit, M.D. (Principal Investigator), I. Polis (Coordinator), T. Polis, M.D. (Coordinator), E.A. Atack, M.D., D.M. Atack, M.D., A. Buchan, M.D., J.M.E.G. Belanger, M.D., G.H. Embree, M.D., D.N. Preston, M.D., and N. Russell, M.D.; University of Oregon, Portland: B.M. Coull, M.D. (Principal Investigator), P. de Garmo, A.N.P. (Coordinator), P. Marshall (Coordinator), D. Briley, M.D., G. Moneta, M.D., S. Roman-Goldstein, M.D., and R. Yeager, M.D.; Marshfield Medical Research Foundation, Marshfield, Wis.: P. Karanjia, M.D. (Principal Investigator), C. Matti, R.N. (Coordinator), L. O'Rourke (Coordinator), B. Brink, M.D., R. Carlson, M.D., B. Hiner, M.D., L. Kolts, M.D., M. Kuehner, M.D., K. Madden, M.D., and M. Swanson, M.D.; University of Montreal, Montreal: L.H. Lebrun, M.D. (Principal Investigator), M.P. Desrochers, R.N. (Coordinator), A. Bellavance, M.D., L. Choimiere, M.D., P. Couillard, M.D., N. Daneault, M.D., M. Duplessis, M.D., S. Fontaine, M.D., S. Lauzier, M.D., J. Raymond, M.D., G. Rowny, M.D., and A. Sfier, M.D.; University of Iowa, Iowa City: H. Adams, M.D. (Principal Investigator), V. Mitchell, R.N. (Coordinator), J. Biller, M.D., S.H. Cornell, M.D., J.D. Corson, M.D., and C. Loftus, M.D.; Dartmouth College, Hanover, N.H.: A.G. Reeves, M.D. (Principal Investigator), P. Orem, B.S., R.N. (Coordinator), L. Cromwell, M.D., R.E. Harbaugh, M.D., and R.E. Nordgren, M.D.; Laval University (Hôpital St.-Sacrement), Quebec City, Que.: E. Daigle, M.D. (Principal Investigator), L. Lessard, R.N. (Coordinator), Y. Douville, M.D., R. Labbe, M.D., F. Laroche, M.D., and H.P. Noel, M.D.; McGill University (Montreal General Hospital), Montreal: R. Cote, M.D. (Principal Investigator), F. Bourque, R.N. (Coordinator), S. Campion, R.N. (Coordinator), J.L. Caron, M.D., J.D. Chan, M.D., R. Ford, M.D., and D.S. Mulder, M.D.; Sunnybrook Medical Center, Toronto: J.W. Norris, M.D. (Principal Investigator), B. Bowyer (Coordinator), J. Twiner (Coordinator), P.W. Cooper, M.D., M. Fazl, M.D., M.J. Gawel, M.D., R. Maggisano, M.D., and D.W. Rowed, M.D.; University of Texas, Dallas: G.P. Clagett, M.D. (Principal Investigator), J.A. Heller, R.N. (Coordinator), A. Pruitt, R.N. (Coordinator), S. Myers, M.D., P. Purdy, M.D., and H. Unwin, M.D.; Mississauga Hospital, Mississauga, Ont.: G. Sawa, M.D. (Principal Investigator), G. Barnard (Coordinator), C. Kennedy, R.N. (Coordinator), V. Ozolins, M.D., and H. Schutz, M.D.; University of Minnesota, Minneapolis: S. Haines, M.D. (Principal Investigator), N. Olson, R.N. (Coordinator), J. Abel, R.N. (Coordinator), J. Davenport, M.D., R.C. Heros, M.D., M.J. Nelson, M.D., and D.A. Turner, M.D.; University of Pittsburgh, Pittsburgh: O. Reinmuth, M.D. (Principal Investigator), S. DeCesare (Coordinator), M. Webster, M.D., and L. Wechsler, M.D.; University of Manitoba, Winnipeg: B. Anderson, M.D. (Principal Investigator), D. Gladish, R.N. (Coordinator), A. Auty, M.D., B. McClarty, M.D., G. Sutherland, M.D., and M. West, M.D.; Brown University, Providence, R.I.: J.D. Easton, M.D. (Principal Investigator), J.A. Sarafin, R.N. (Coordinator), R.A. Haas, M.D., and N. Knuckey, M.D.; State University of New York, Syracuse: A. Culebras, M.D. (Principal Investigator), J. Drucker, R.N. (Coordinator), C. Law, R.N. (Coordinator), E. Cacayorin, M.D., and C. Hodge, M.D.; McMasler University, Hamilton, Ont.: R. Duke, M.D. (Principal Investigator), P. Trevisani, R.N. (Coordinator), M. Alesi, R.N. (Coordinator), M. Molot, M.D., and J.D. Wells, M.D.; Ohio Slate University, Columbus: A.P. Slivka, M.D. (Principal Investigator), T. Brink, R.N. (Coordinator)J. Durham, M.D., W.L. Smead, M.D., A.E. Stockum, M.D., and J.G. Wright, M.D.; University of Texas, San Antonio: D.G. Sherman, M.D. (Principal Investigator), C. Sherman, R.N. (Coordinator), C. Easton, R.N. (Coordinator), R.G. Hart, M.D., W. Rogers, M.D., H.D. Root, M.D., and C. Tegeler, M.D.; University of Calgary, Calgary, Alb.: K.M. Hoyte, M.D. (Principal Investigator), M. Robertson, R.N. (Coordinator), K.M. Hunter, M.D, S.T. Myles, M.D., R. Ramsay, M.D., H.A. Swanson, M.D., and B.I. Tranmer, M.D.; University of Missouri, Columbia: J. Byer, M.D. (Principal Investigator), C. Kelley, R.N. (Coordinator), M.K. Gumerlock, M.D., M. Nelson, M.D., and J. Oro, M.D.; University of Southern California, Los Angeles: M. Fisher, M.D. (Principal Investigator), J. Ahmadi, M.D., S. Ameriso, M.D. (Coordinator), F. Weaver, M.D., and A.E. Yellin, M.D.; Dalhousie University, Halifax, N.S.: C.W. McCormick, M.D. (Principal Investigator), J. McCormick, R.N. (Coordinator), R.O. Holness, M.D., W.J. Howes, M.D., G. Llewellyn, M.D., D. Malloy, M.D., and S. Phillips, M.D.; University of Miami, Miami: R.E. Kelley, Jr., M.D. (Principal Investigator), L. Solari, R.N., B.S.N. (Coordinator), R. Safon, R.N. (Coordinator), J. Kochan, M.D., and A.S. Livingstone, M.D.; University of Texas, Houston: J. Grotta, M.D. (Principal Investigator), P. Bratina, R.N. (Coordinator), G. Clifton, M.D., and J. Yeakley, M.D.; Albert Einstein College of Medicine, Bronx, N.Y.: D. Rosenbaum, M.D. (Principal Investigator), E. Klonowski, R.N. (Coordinator), R. de los Reyes, M.D., S. Gupta, M.D., F. Moser, M.D., F. Veith, M.D., and K. Wengerter, M.D.; Boston University, Boston: P.A. Wolf, M.D. (Principal Investigator), E. Licata-Gehr, R.N., M.S.N. (Coordinator), N.C. Allen, R.N., M.S.N. (Coordinator), V.L. Babikian, M.D., N. Cantelmo, M.D., C.S. Kase, M.D., and J.O. Menzoian, M.D.; St. Louis University, St. Louis: C. Gomez, M.D. (Principal Investigator), M. Jedlicka, R.N. (Coordinator), Y. Yusufaly, M.D. (Coordinator), E. Awwad, M.D., R. Bucholz, M.D., and K.R. Smith, Jr., M.D.; University of Alberta, Edmonton: M.G. Elleker, M.D. (Principal Investigator), E. Hutchings, R.N. (Coordinator), G. Andrew, M.D., R. Ashforth, M.D., B. Bharadwaj, M.D., and J.M. Findlay, M.D.; University of Illinois, Chicago/Peoria: C.M. Helgason, M.D. (Principal Investigator), S. Clemons, R.N. (Coordinator), J. Arzbaecher, R.N. (Coordinator), M. Budi, R.N. (Coordinator), R. Crowell, M.D., J. DeBord, M.D., and J. Schuler, M.D.; University of Mississippi, Jackson: R.R. Smith, M.D. (Principal Investigator), R.L. Brown, R.N. (Coordinator), A.F. Haerer, M.D., and W. Russell, M.D.; Beth Israel Hospital, Boston: C. Mayman, M.D. (Principal Investigator), M. Tijerina, R.N. (Coordinator), K.C. Kent, M.D., J. Kleefield, M.D., and J.J. Skillman, M.D.; Temple University, Philadelphia: R.H. Rosenwasser, M.D. (Principal Investigator), G. Larese-Ortiz (Coordinator), B. Tournier (Coordinator), A.J. Comerota, M.D., D. Jamieson, M.D., and T. Liu, M.D.; McGill University (Jewish General Hospital/Notre Dame Hospital), Montreal: G. Mohr, M.D. (Principal Investigator), S. Entis, R.N. (Coordinator), P. LaPlante, R.N. (Coordinator), S. Brem, M.D., J. Carlton, M.D., and M. Goldenberg, M.D.; University of Tennessee, Memphis: J.T. Robertson, M.D. (Principal Investigator), J. Riley, R.N. (Coordinator), J. Connell, R.N. (Coordinator), F. Eggers, M.D., and S. Erkulwater, M.D.; Barrow Neurological Institute, Phoenix, Ariz.: R. Spetzler, M.D. (Principal Investigator), H. Jahnke, R.N. (Coordinator), J. Frey, M.D., and J. Hodak, M.D.; University of Saskatchewan, Saskatoon: A. Shuaib, M.D. (Principal Investigator), C. Regier, R.N. (Coordinator), and F.M. Denath, M.D.; Memorial University, St. John's, Newf.: A.E. Goodridge, M.D. (Principal Investigator), K. Murphy, R.N. (Coordinator), A. Badejo, M.D., and M. Mangan, M.D.; Good Samaritan Hospital, Cincinnati: R.E. Welling, M.D. (Principal Investigator), D. Feldman, B.A. (Coordinator), R. Lukin, M.D., and R.L. Reed, M.D.; University of California, San Diego: J. Rothrock, M.D. (Principal Investigator), N. Kelly, R.N. (Coordinator), K. Hogan, R.N. (Coordinator), R.J. Hye, M.D., and J. Hesselink, M.D.; University of New Mexico, Albuquerque: L. Kesterson, M.D. (Principal Investigator), L. Rivera, R.N. (Coordinator), K. Martinez, R.N. (Coordinator), A. Bruno, M.D., and A. Champlin, M.D.; Wadsworth Veterans Affairs Hospital, Los Angeles: S.N. Cohen, M.D. (Principal Investigator), J. Kawafuchi, R.N. (Coordinator), J.G. Frazee, M.D., J. Freischlag, M.D., N. Martin, M.D., G. Peters, M.D., and G. White, M.D.; Neurological Institute, New York: J.P. Mohr, M.D. (Principal Investigator), A. Cruz, R.N. (Coordinator), S.K. Hilal, M.D., and D. Quest, M.D.
Management Staff (Mayo Clinic, McMaster University, and the John P. Robarts Research Institute): L. Bailey, P. Beattie, B. Bergman, E. Bosch, R. Cook, M. Douglas, J. French, M.J. Gagnon, M.J. Livingstone, H. Meldrum, D. Pahl, D. Kaderabek, J. Richardson, B. Sharpe, C. Swan, C. White, and M. Wright; Staff Neurologists — O. Benavente, M.D., M. Brown, M.D., I. Meissner, M.D., T. Mirsen, M.D., and J. Streifler, M.D. Adjudicating Committee: T. Brott, M.D. (neurologist), J. D'Alton, M.D. (neurologist), R. Gunton, M.D. (cardiologist), I. Kricheff, M.D. (neuroradiologist), J. Little, M.D. (neurosurgeon), T. Riles, M.D. (vascular surgeon), J. Robertson, M.D. (neurosurgeon), and G. Wortzman, M.D. (neuroradiologist). Monitoring Committee: M.D. Walker, M.D. (Chairman, National Institute of Neurological Disorders and Stroke), B. Brown, Jr., Ph.D. (Stanford University), E.S. Flamm, M.D. (New York University), A.M. Imparato, M.D. (New York University), J.R. Marler, M.D. (National Institute of Neurological Disorders and Stroke), R.G. Ojemann, M.D. (Massachusetts General Hospital), W. Powers, M.D. (Washington University), T. Price, M.D. (University of Maryland), and D.E. Strandness, M.D. (University of Washington).
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Leslie Bleeker, Henk A. Marquering, René Berg, Paul J. Nederkoorn, Charles B. Majoie. (2011) Semi-automatic quantitative measurements of intracranial internal carotid artery stenosis and calcification using CT angiography. Neuroradiology
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S. C. Knipp, A. Scherag, F. Beyersdorf, J. Cremer, H.-C. Diener, J. A. Haverich, H. G. Jakob, W. Mohr, C. Ose, H. Reichenspurner, G. Walterbusch, A. Welz, C. Weimar, . (2011) Randomized comparison of synchronous CABG and carotid endarterectomy vs. isolated CABG in patients with asymptomatic carotid stenosis: The CABACS trial. International Journal of Stroken/a-n/a
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Lysa Legault Kingstone, Geoffrey M. Currie, Carlos Torres. (2011) The Pathogenesis, Analysis, and Imaging Methods of Atherosclerotic Disease of the Carotid Artery: Review of the Literature. Journal of Medical Imaging and Radiation Sciences
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Christophe Camiade, Amer Maher, Jean-Baptiste Ricco, Jérôme Roumy, Guillaume Febrer, Christophe Marchand, Jean-Philippe Neau. (2003) Carotid bypass with polytetrafluoroethylene grafts: a study of 110 consecutive patients. Journal of Vascular Surgery 38:5, 1031-1037
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Kuniaki Ogasawara, Hirotsugu Yukawa, Masakazu Kobayashi, Chiaki Mikami, Hiromu Konno, Kazunori Terasaki, Takashi Inoue, Akira Ogawa. (2003) Prediction and monitoring of cerebral hyperperfusion after carotid endarterectomy by using single-photon emission computerized tomography scanning. Journal of Neurosurgery 99:3, 504-510
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Tomoaki Terada, Mitsuharu Tsuura, Hiroyuki Matsumoto, Osamu Masuo, Hiroo Yamaga, Tomoyuki Tsumoto, Toru Itakura. (2003) Results of Endovascular Treatment of Internal Carotid Artery Stenoses with a Newly Developed Balloon Protection Catheter. Neurosurgery 53:3, 617-625
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John D. Barr, John J. Connors, David Sacks, Joan C. Wojak, Gary J. Becker, John F. Cardella, Bohdan Chopko, Jacques E. Dion, Allan J. Fox, Randall T. Higashida, Robert W. Hurst, Curtis A. Lewis, Terence A.S. Matalon, Gary M. Nesbit, J. Arliss Pollock, Eric J. Russell, David J. Seidenwurm, Robert C. Wallace. (2003) Quality Improvement Guidelines for the Performance of Cervical Carotid Angioplasty and Stent Placement. Journal of Vascular and Interventional Radiology 14:9, S321-S335
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Adnan I. Qureshi, Charlene Knape, John Maroney, M. Fareed K. Suri, L. Nelson Hopkins. (2003) Multicenter clinical trial of the NexStent coiled sheet stent in the treatment of extracranial carotid artery stenosis: immediate results and late clinical outcomes. Journal of Neurosurgery 99:2, 264-270
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Kong T Tan, Trevor J Cleveland, Viktor Berczi, Fiona M McKevitt, Graham S Venables, Peter A Gaines. (2003) Timing and frequency of complications after carotid artery stenting: what is the optimal period of observation?. Journal of Vascular Surgery 38:2, 236-243
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Guy Lesèche, Yves Castier, Olivier Chataigner, Fady Francis, Mathieu Besnard, Gabriel Thabut, Eddie Abdalla, Olivier Cerceau. (2003) Carotid artery revascularization through a radiated field. Journal of Vascular Surgery 38:2, 244-250
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E. VANNINEN, J. T. KUIKKA, M. ÄIKIÄ, M. KÖNÖNEN, R. VANNINEN. (2003) Heterogeneity of cerebral blood flow in symptomatic patients undergoing carotid endarterectomy. Nuclear Medicine Communications 24:8, 893-900
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Kuniaki Ogasawara, Hiromu Konno, Hirotsugu Yukawa, Hidehiko Endo, Takashi Inoue, Akira Ogawa. (2003) Transcranial Regional Cerebral Oxygen Saturation Monitoring during Carotid Endarterectomy as a Predictor of Postoperative Hyperperfusion. Neurosurgery 53:2, 309-315
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M.H Christiaans, J.M.P.G Ernst, M.J Suttorp, J.C van den Berg, T.Th.C Overtoom, J.C Kelder, H.W Mauser, R.G.A Ackerstaff. (2003) Restenosis after Carotid Angioplasty and Stenting: a Follow-up Study with Duplex Ultrasonography. European Journal of Vascular and Endovascular Surgery 26:2, 141-144
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Ida Sim, Steven R. Cummings. (2003) A New Framework for Describing and Quantifying the Gap Between Proof and Practice. Medical Care 41:8, 874-881
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A.R Naylor, P.M Rothwell, P.R.F Bell. (2003) Overview of the Principal Results and Secondary Analyses from the European and North American Randomised Trials of Endarterectomy for Symptomatic Carotid Stenosis. European Journal of Vascular and Endovascular Surgery 26:2, 115-129
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Stefan Engelter, Philippe Lyrer, Philippe Lyrer. 2003. Antiplatelet therapy for preventing stroke and other vascular events after carotid endarterectomy. .
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Aliza T Brown, Todd P Smith, Carlos P Cruz, Lionel A Poirier, Debra Simmons, D.Keith Williams, Yunfang Wang, John F Eidt, Mohammed M Moursi. (2003) Intimal hyperplasia following carotid endarterectomy in an insulin-resistant rat model. Metabolism 52:7, 834-839
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Mark F Conrad, Alexander D Shepard, Keshav Pandurangi, Manesh Parikshak, Timothy J Nypaver, Daniel J Reddy, Jae-Sung Cho. (2003) Outcome of carotid endarterectomy in African Americans: is race a factor?1 1Competition of interest: nil.. Journal of Vascular Surgery 38:1, 129-137
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Ian A. Herrick. (2003) Cerebrovascular disease. Current Opinion in Anaesthesiology 16:3, 337-342
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Ali F. AbuRahma, Eric S. Hopkins, Patrick A. Robinson, John T. Deel, Samir Agarwal. (2003) Prospective Randomized Trial of Carotid Endarterectomy With Polytetrafluoroethylene Versus Collagen-Impregnated Dacron (Hemashield) Patching: Late Follow-Up. Annals of Surgery 237:6, 885-893
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John Crossman, Kathryn Banister, Val Bythell, Robert Bullock, Iain Chambers, A David Mendelow. (2003) Predicting clinical ischaemia during awake carotid endarterectomy: use of the SJVO2 probe as a guide to selective shunting. Physiological Measurement 24:2, 347-354
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E. Ascher, A. Hingorani, N. Markevich, R. Schutzer, W.R. Yorkovich, S. Kallakuri, B. Tsemekhim. (2003) Carotid Surgery without External Carotid Endarterectomy: A 6-year Clinical Experience with 1027 Cases. European Journal of Vascular and Endovascular Surgery 25:5, 458-461
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Tomoaki Terada, Mitsuharu Tsuura, Hiroyuki Matsumoto, Osamu Masuo, Tomoyuki Tsumoto, Hiroo Yamaga, Toru Itakura. (2003) Endovascular therapy for stenosis of the petrous or cavernous portion of the internal carotid artery: percutaneous transluminal angioplasty compared with stent placement. Journal of Neurosurgery 98:3, 491-497
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Ricardo A. Hanel, Andrew R. Xavier, Jawad F. Kirmani, Abutaher M. Yahia, Adnan I. Qureshi. (2003) Management of carotid artery stenosis: Comparing endarterectomy and stenting. Current Cardiology Reports 5:2, 153-159
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Ramachandra P. Tummala, Ray M. Chu, Eric S. Nussbaum. (2003) Extracranial–intracranial bypass for symptomatic occlusive cerebrovascular disease not amenable to carotid endarterectomy. Neurosurgical FOCUS 14:3, 1-4
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Robert L. Grubb, William J. Powers, Colin P. Derdeyn, Harold P. Adams, William R. Clarke. (2003) The Carotid Occlusion Surgery Study. Neurosurgical FOCUS 14:3, 1-7
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N. S. Lennard, C. Vijayasekar, C. Tiivas, C. W. M. Chan, D. J. Higman, C. H. E. Imray. (2003) Control of emboli in patients with recurrent or crescendo transient ischaemic attacks using preoperative transcranial Doppler-directed Dextran therapy. British Journal of Surgery 90:2, 166-170
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Geoffrey A. Donnan, Stephen M. Davis, Amanda Thrift. (2003) The role of blood pressure lowering before and after stroke. Current Opinion in Neurology 16:1, 81-86
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Masanori TSUTSUMI, Kiyoshi KAZEKAWA, Akira TANAKA, Hiroshi AIKAWA, Yasuyuki NOMOTO, Kohei NII, Nobuyuki SAKAI. (2003) Improved Cerebral Perfusion After Simultaneous Stenting for Tandem Stenoses of the Internal Carotid Artery-Two Case Reports-. Neurologia medico-chirurgica 43:8, 386-390
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Michelle S. Kim, Daniel J. Cole. (2003) Chapter 9 Anesthesia for Carotid Surgery. ASA Refresher Courses in Anesthesiology 31:1, 91-104
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Takenori Yamaguchi. (2003) Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics 40:3, 223-227
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Yeon Sik YUN, Shoichi KATO, Tatsuo AKIMURA, Michiyasu SUZUKI. (2003) Neurosonology 16:2, 93-96
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Ronald L. Wolf, David C. Alsop, Michael L. McGarvey, Joseph A. Maldjian, Jiongjiong Wang, John A. Detre. (2003) Susceptibility Contrast and Arterial Spin Labeled Perfusion MRI in Cerebrovascular Disease. Journal of Neuroimaging 13:1, 17-27
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Takeshi MIKAMI, Akira TAKAHASHI, Kiyohiro HOUKIN. (2003) Evaluation of Blood Flow in Carotid Artery Stenosis Using B-Flow Sonography. Neurologia medico-chirurgica 43:11, 528-533
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Sabine Steiner, Ramazanali Ahmadi, Andrea Willfort, Wilfried Lang, Kurt Huber, Erich Minar, Christoph W. Kopp. (2003) Hemostatic markers with bolus versus prolonged heparin after carotid artery stenting. Thrombosis Research 109:1, 23-29
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Oh Young Bang, In Soo Joo, Kyoon Huh, Sun Yong Kim. (2003) The Role of Transcranial Doppler in Symptomatic Striatocapsular Small Deep Infarction. Journal of Neuroimaging 13:1, 48-52
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Carlos S. Kase, Conrado J. Estol. 2003. Atherothrombotic Cerebral Infarction. , 293-299.
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Frank Lefevre, Judi M Woolger. (2003) Surgery in the patient with neurologic disease. Medical Clinics of North America 87:1, 257-271
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J. Michael Bacharach, David P. Slovut. (2003) Endovascular Therapies for Vascular Disease. The American Heart Hospital Journal 1:1, 69-76
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Michelle S. Kim, Daniel J. Cole. (2003) Anesthesia for Carotid Surgery. ASA Refresher Courses in Anesthesiology 31:1, 91-103
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Takashi INOUE, Kuniaki OGASAWARA, Hiromu KONNO, Akira OGAWA, Hiroyuki KABASAWA. (2003) Diffusion Tensor Imaging in Patients With Major Cerebral Artery Occlusive Disease. Neurologia medico-chirurgica 43:9, 421-426
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Toshihiko Nanke, Naoki Matsumoto, Hirofumi Wakimoto, Kiyoshi Nakazawa, Fumihiko Miyake, Hirofumi Watanabe, Masahiro Horiuchi, Yoichi Takahashi. (2003) Reversible Ischemic Neurological Deficit (RIND) due to Exercise Testing for the Diagnosis of Angina Pectoris. Japanese Heart Journal 44:4, 575-581
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Mark H. Wholey, Chester R. Jarmolowski, Michael Wholey, Gustav R. Eles. (2003) Carotid Artery Stent Placement—Ready for Prime Time?. Journal of Vascular and Interventional Radiology 14:1, 1-10
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Andrew J. Ringer, L. Nelson Hopkins. 2003. Carotid Angioplasty and Stenting. , 513-514.
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Gordana Arandjelovic-Minic. (2003) Sensitivity of hemodynamic parameters obtained by conventional duplex scanner in the evaluation of extracranial carotid disease severity. Vojnosanitetski pregled 60:4, 435-442
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Dragana Obradovic, Branko Gligic, Slobodan Obradovic, Smiljana Popovic, Jasmina Maksic, Natasa Vukotic. (2003) Statins and stroke. Vojnosanitetski pregled 60:4, 461-470
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Sibu P. Saha, Anthony G. Rogers, Gary F. Earle, Craig A. Nachbauer, Robert O. Mitchell, Bassam A. Khalil, Saeid Khansarinia. (2002) Carotid endarterectomy in octagenarians and nonagenarians in a community hospital: An outcome analysis. International Journal of Angiology 11:1, 38-40
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L.M. Pedro, J. Fernandes e Fernandes, M.M. Pedro, I. Gonçalves, N.V. Dias, R. Fernandes e Fernandes, T.F. Carneiro, C. Balsinha. (2002) Ultrasonographic Risk Score of Carotid Plaques. European Journal of Vascular and Endovascular Surgery 24:6, 492-498
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John A Cowan, Justin B Dimick, B.Gregory Thompson, James C Stanley, Gilbert R Upchurch. (2002) Surgeon volume as an indicator of outcomes after carotid endarterectomy. Journal of the American College of Surgeons 195:6, 814-821
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Hans-Christoph Diener, Peter Ringleb. (2002) Antithrombotic secondary prevention after stroke. Current Treatment Options in Cardiovascular Medicine 4:5, 429-440
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J.C. Parodi, R. La Mura, L.M. Ferreira. (2002) Brachial to Carotid Shunt for Carotid Endarterectomy. European Journal of Vascular and Endovascular Surgery 24:4, 370-371
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MARKUS LENHART, NICOLA FRAMME, MARKUS VÖLK, MICHAEL STROTZER, CHRISTOPH MANKE, WOLFGANG R. NITZ, THOMAS FINKENZELLER, STEFAN FEUERBACH, JOHANN LINK. (2002) Time-Resolved Contrast-Enhanced Magnetic Resonance Angiography of the Carotid Arteries. Investigative Radiology 37:10, 535-541
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Kenneth T. Pace, R. John D'A. Honey. (2002) Unique Methodological Issues Facing Randomized Controlled Trials of Endourologic Procedures. Journal of Endourology 16:7, 457-463
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István Karádi, Zsuzsa Mészáros, Attila Csányi, Tamás Szombathy, Nóra Hosszúfalusi, László Romics, Kálmán Magyar. (2002) Serum semicarbazide-sensitive amine oxidase (SSAO) activity is an independent marker of carotid atherosclerosis. Clinica Chimica Acta 323:1-2, 139-146
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Andrew J. Ringer, John W. German, Lee R. Guterman, L. Nelson Hopkins. (2002) Follow-up of Stented Carotid Arteries by Doppler Ultrasound. Neurosurgery 51:3, 639-643
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Erik Meijering, Wiro Niessen, Joachim Weickert, Max Viergever. (2002) Diffusion-enhanced visualization and quantification of vascular anomalies in three-dimensional rotational angiography: Results of an in-vitro evaluation. Medical Image Analysis 6:3, 215-233
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Shintaro Watanabe, Junichi Narita, Kazuomi Kario. (2002) Two elderly cases of nocturnal onset stroke with stenosis of carotid arteries during the treatment of hypertension. Geriatrics and Gerontology International 2:3, 153-156
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George R. Bergus, Irwin P. Levin, Arthur S. Elstein. (2002) Presenting Risks and Benefits to Patients. The Effect of Information Order on Decision Making. Journal of General Internal Medicine 17:8, 612-617
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Philip P Goodney, Andrea E Siewers, Therese A Stukel, F.Lee Lucas, David E Wennberg, John D Birkmeyer. (2002) Is surgery getting safer? National trends in operative mortality1,2 1No competing interests declared. 2The views expressed herein do not necessarily represent the views of the Department of Veterans Affairs or the United States Government.. Journal of the American College of Surgeons 195:2, 219-227
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Michele M. Ciulla, Roberta Paliotti, Stefano Ferrero, Pierluigi Vandone, Fabio Magrini, Alberto Zanchetti. (2002) Assessment of carotid plaque composition in hypertensive patients by ultrasonic tissue characterization: a validation study. Journal of Hypertension 20:8, 1589-1596
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C.Douglas Phillips, Lori A Bubash. (2002) CT angiography and MR angiography in the evaluation of extracranial carotid vascular disease. Radiologic Clinics of North America 40:4, 783-798
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A. Long, A. Lepoutre, Corbillon, A. Branchereau. (2002) Critical Review of Non- or Minimally Invasive Methods (Duplex Ultrasonography, MR- and CT-angiography) for Evaluating Stenosis of the Proximal Internal Carotid Artery. European Journal of Vascular and Endovascular Surgery 24:1, 43-52
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Nancy J. O. Birkmeyer, James N. Weinstein, Anna N. A. Tosteson, Tor D. Tosteson, Jonathan S. Skinner, Jon D. Lurie, Richard Deyo, John E. Wennberg. (2002) Design of the Spine Patient Outcomes Research Trial (SPORT). Spine 27:12, 1361-1372
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Julian E. Bailes. (2002) Carotid Endarterectomy. Neurosurgery 50:6, 1290-1295
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VICKI A. LYONS-WAIT, SHEILA F. ANDERSON, JOHN C. TOWNSEND, PAUL DE LAND. (2002) Ocular and Systemic Findings and Their Correlation with Hemodynamically Significant Carotid Artery Stenosis: A Retrospective Study. Optometry and Vision Science 79:6, 353-362
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Yong Pil Cho, Tae Won Kwon, Geun Eun Kim. (2002) Sonographic appearance of a free-floating atheromatous plaque in a patient with acute stroke. Journal of Clinical Ultrasound 30:5, 317-321
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Jose I. Suarez, Adnan I. Qureshi, Abutaher B. Yahia, Parak D. Parekh, Rafael J. Tamargo, Michael A. Williams, John A. Ulatowski, Daniel F. Hanley, Alexander Y. Razumovsky. (2002) Symptomatic vasospasm diagnosis after subarachnoid hemorrhage: Evaluation of transcranial Doppler ultrasound and cerebral angiography as related to compromised vascular distribution. Critical Care Medicine 30:6, 1348-1355
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M. Pai, A. Handa, L. Hands. (2002) Adequate Vascular Training Opportunities can be Provided Without Compromising Patient Care. European Journal of Vascular and Endovascular Surgery 23:6, 524-527
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K. Rerkasem, C.P. Shearman, J.A. Williams, G.E. Morris, M.J. Phillips, R.F. Grimble. (2002) C-reactive Protein is Elevated in Symptomatic Compared with Asymptomatic Patients with Carotid Artery Disease. European Journal of Vascular and Endovascular Surgery 23:6, 505-509
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Adnan I. Qureshi, M. Fareed K. Suri, Gishel New, Daniel C. Wadsworth, Joan Dulin, L. Nelson Hopkins. (2002) Multicenter study of the feasibility and safety of using the Memotherm carotid arterial stent for extracranial carotid artery stenosis. Journal of Neurosurgery 96:5, 830-836
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Richard Bond, Kittipan Rerkasem, Peter M Rothwell, Richard Bond. 2002. Routine or selective carotid artery shunting for carotid endarterectomy (and different methods of monitoring in selective shunting). .
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Robert W Hobson, Brajesh K. Lal, Elie Y. Chakhtoura, Jonathan Goldstein, Richard Kubicka, Paul B. Haser, Frank T. Padberg, Peter J. Pappas, Zafar Jamil. (2002) Carotid artery closure for endarterectomy does not influence results of angioplasty-stenting for restenosis. Journal of Vascular Surgery 35:3, 435-438
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Enzo Ballotta, Giuseppe Da Giau, Claudio Baracchini, Elvira Abbruzzese, Marina Saladini, Giorgio Meneghetti. (2002) Early versus delayed carotid endarterectomy after a nondisabling ischemic stroke: A prospective randomized study. Surgery 131:3, 287-293
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Angelo Anzuini, Carlo Briguori, Gary S Roubin, Salvatore Rosanio, Flavio Airoldi, Mauro Carlino, Paolo Pagnotta, Carlo Di Mario, Imad Sheiban, Giuseppe Magnani, Antonio Jannello, Germano Melissano, Roberto Chiesa, Antonio Colombo. (2001) Emergency stenting to treat neurological complications occurring after carotid endarterectomy. Journal of the American College of Cardiology 37:8, 2074-2079
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J Mocco, Tanvir F. Choudhri, William J. Mack, Ilya Laufer, James Lee, Szilard Kiss, Alexander Poisik, Donald O. Quest, Robert A. Solomon, E. Sander Connolly. (2001) Elevation of Soluble Intercellular Adhesion Molecule-1 Levels in Symptomatic and Asymptomatic Carotid Atherosclerosis. Neurosurgery 48:4, 718-722
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Stephen R. Ramee, Robert Dawson, Kevin L. McKinley, Robert Felberg, Tyrone J. Collins, J. Stephen Jenkins, Mohammed I. Awaad, Christopher J. White. (2001) Provisional stenting for symptomatic intracranial stenosis using a multidisciplinary approach: Acute results, unexpected benefit, and one-year outcome. Catheterization and Cardiovascular Interventions 52:4, 457-467
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L.M. Pedro, M.M. Pedro, I. Gonçalves, T.F. Carneiro, C. Balsinha, R. Fernandes e Fernandes, J. Fernandes e Fernandes. (2000) Computer-assisted Carotid Plaque Analysis: Characteristics of Plaques Associated with Cerebrovascular Symptoms and Cerebral Infarction. European Journal of Vascular and Endovascular Surgery 19:2, 118-123
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Piergiorgio Cao, Giuseppe Giordano, Paola De Rango, Simona Zannetti, Roberto Chiesa, Gioacchino Coppi, Domenico Palombo, Flavio Peinetti, Carlo Spartera, Vincenzo Stancanelli, Enrico Vecchiati. (2000) Eversion versus conventional carotid endarterectomy: Late results of a prospective multicenter randomized trial. Journal of Vascular Surgery 31:1, 19-30
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Changyi Chen, Michael E. Halkos, Scott M. Surowiec, Brian S. Conklin, Peter H. Lin, Alan B. Lumsden. (2000) Effects of Homocysteine on Smooth Muscle Cell Proliferation in Both Cell Culture and Artery Perfusion Culture Models. Journal of Surgical Research 88:1, 26-33
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Noriyuki Kohda, Takeshi Tani, Sunao Nakayama, Tomoya Adachi, Keiko Marukawa, Rieko Ito, Kazuaki Ishida, Yutaka Matsumoto, Yukio Kimura. (1999) Effect of Cilostazol, a Phosphodiesterase III Inhibitor, on Experimental Thrombosis in the Porcine Carotid Artery. Thrombosis Research 96:4, 261-268
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Kim A. Eagle, Robert A. Guyton, Ravin Davidoff, Gordon A. Ewy, James Fonger, Timothy J. Gardner, John Parker Gott, Howard C. Herrmann, Robert A. Marlow, William C. Nugent, Gerald T. O’Connor, Thomas A. Orszulak, Richard E. Rieselbach, William L. Winters, Salim Yusuf, Raymond J. Gibbons, Joseph S. Alpert, Kim A. Eagle, Timothy J. Gardner, Arthur Garson, Gabriel Gregoratos, Richard O. Russell, Sidney C. Smith. (1999) ACC/AHA guidelines for coronary artery bypass graft surgery. Journal of the American College of Cardiology 34:4, 1262-1347
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G.Patrick Clagett. (1998) Presidential Address: Trials of the Southern Association for Vascular Surgery. Journal of Vascular Surgery 28:3, 391-396
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Michael H. Wholey, Mark Wholey, Patrice Bergeron, Edward B. Diethrich, Michel Henry, Jean C. Laborde, Klaus Mathias, Subbarao Myla, Gary S. Roubin, Fayaz Shawl, Jacque G. Theron, Jay S. Yadav, Gerry Dorros, Juan Guimaraens, Randal Higashida, Vijay Kumar, Martin Leon, Michael Lim, Hugo Londero, Juan Mesa, Steve Ramee, Adolfo Rodriguez, Kenneth Rosenfield, George Teitelbaum, Carlos Vozzi. (1998) Current global status of carotid artery stent placement. Catheterization and Cardiovascular Diagnosis 44:1, 1-6
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Richard R. Heuser. (1998) Success with carotid stenting: A stroke of good luck or the wave of the future?. Catheterization and Cardiovascular Diagnosis 44:1, 7-8
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Takao Ohki, Michael L. Marin, Ross T. Lyon, George L. Berdejo, Krish Soundararajan, Mika Ohki, John G. Yuan, Peter L. Faries, Reese A. Wain, Luis A. Sanchez, William D. Suggs, Frank J. Veith. (1998) Ex vivo human carotid artery bifurcation stenting: Correlation of lesion characteristics with embolic potential. Journal of Vascular Surgery 27:3, 463-471
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C.D. Irvine, F.V. Gardner, A.H. Davies, P.M. Lamont. (1998) Cognitive testing in patients undergoing carotid endarterectomy. European Journal of Vascular and Endovascular Surgery 15:3, 195-204
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Dongping Yin, Jeffrey P. Carpenter. (1998) Cost-effectiveness of screening for asymptomatic carotid stenosis. Journal of Vascular Surgery 27:2, 245-255
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Bernard Sigel. (1998) A Brief History of Doppler Ultrasound in the Diagnosis of Peripheral Vascular Disease. Ultrasound in Medicine & Biology 24:2, 169-176
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Cathy A. Sila. (1998) NEUROLOGIC COMPLICATIONS OF VASCULAR SURGERY. Neurologic Clinics 16:1, 9-20
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H. Krapf, B. Kleiser, B. Widder. (1997) Risk of thrombembolic and hemodynamic stroke in carotid artery occlusions. Klinische Neuroradiologie 7:4, 205-211
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G HUNTER. (1997) The clinical and pathologic spectrum of recurrent carotid stenosis. The American Journal of Surgery 174:6, 583-588
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KLAUS MATHIAS. (1997) Part II: Stent Placement in Arteriosclerotic Disease of the Internal Carotid Artery. Journal of Interventional Cardiology 10:6, 469-477
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J. Golledge, R. Cuming, M. Ellis, A. H. Davies, R. M. Greenhalgh. (1997) Carotid plaque characteristics and presenting symptom. British Journal of Surgery 84:12, 1697-1701
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John J. Ricotta, Monica S. O'Brien-Irr. (1997) Conservative management of residual and recurrent lesions after carotid endarterectomy: Long-term results. Journal of Vascular Surgery 26:6, 963-972
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J MAXWELL, R RUTLEDGE, D COVINGTON, M CHURCHILL, T CLANCY. (1997) A statewide, hospital-based analysis of frequency and outcomes in carotid endarterectomy. The American Journal of Surgery 174:6, 655-661
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J.D. Blankensteijn, J. van der Grond, W.P. Mali, B.C. Eikelboom. (1997) Flow volume changes in the major cerebral arteries before and after carotid endarterectomy: an MR angiography study. European Journal of Vascular and Endovascular Surgery 14:6, 446-450
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C GARRARD, J MANORD, B BALLINGER, J KATEIVA, W CHARLESSTERNBERGHIII, J BOWEN, S MONEY. (1997) Cost savings associated with the nonroutine use of carotid angiography. The American Journal of Surgery 174:6, 650-654
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M.-L M. Grønholdt, B.M. Wiebe, H. Laursen, T.G. Nielsen, T.V. Schroeder, H. Sillesen. (1997) Lipid-rich carotid artery plaques appear echolucent on ultrasound B-mode images and may be associated with intraplaque haemorrhage. European Journal of Vascular and Endovascular Surgery 14:6, 439-445
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Raffaele Antonelli Incajzi, Antonella Gemma, Francesco Landi, Francesco Pagano, Oliviero Capparella, Francesco Snider, Raffaele Manni, Pierugo Carbonin. (1997) Neuropsychologic effects of carotid endarterectomy. Journal of Clinical and Experimental Neuropsychology 19:6, 785-794
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MICHAEL R. JAFF. (1997) Part I: Carotid Endarterectomy: What Is Not Always Revealed About Carotid Artery Surgery. Journal of Interventional Cardiology 10:6, 465-467
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J BYRNE. (1997) Interventional neuroradiology: An emerging subspeciality. Clinical Radiology 52:12, 891-902
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Weili Lin, Dana R. Abendschein, Azim Celik, Robert P. Dolan, Randall B. Lauffer, Richard C. Walovitch, E. Mark Haacke. (1997) Intravascular contrast agent improves magnetic resonance angiography of carotid arteries in minipigs. Journal of Magnetic Resonance Imaging 7:6, 963-971
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Nikki Lennard, Julia Smith, Joanne Dumville, Richard Abbott, David H. Evans, Nicholas J.M. London, Peter R.F. Bell, A.Ross Naylor. (1997) Prevention of postoperative thrombotic stroke after carotid endarterectomy: The role of transcranial Doppler ultrasound. Journal of Vascular Surgery 26:4, 579-584
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Sandra C Carr, Andrew Farb, William H Pearce, Renu Virmani, James S.T Yao. (1997) Activated inflammatory cells are associated with plaque rupture in carotid artery stenosis. Surgery 122:4, 757-764
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Philip S.K Paty, R.Clement Darling, Steven Woratyla, Benjamin B Chang, Paul B Kreienberg, Dhiraj M Shah. (1997) Timing of carotid endarterectomy in patients with recent stroke. Surgery 122:4, 850-855
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Martin R. Back, Timothy R.S. Harward, Thomas S. Huber, Lori M. Carlton, Timothy C. Flynn, James M. Seeger. (1997) Improving the cost-effectiveness of carotid endarterectomy. Journal of Vascular Surgery 26:3, 456-464
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Carlo Nucci, Eugenio Martelli, Annalisa Appolloni, Stefano Palma. (1997) A case of central retinal artery occlusion after carotid endoarterectomy. Eye 11:5, 755-757
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Robin S. McLeod. (1997) Clinical trials: A surgeon's perspective. Inflammatory Bowel Diseases 2:1, 27-32
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Gordon H. Martin, Robert C. Allen, Brandy L. Noel, Clement M. Talkington, Wilson V. Garrett, Bertram L. Smith, Gregory J. Pearl, Jesse E. Thompson. (1997) Carotid endarterectomy in patients less than 50 years old. Journal of Vascular Surgery 26:3, 447-455
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G. Melissano, R. Castellano, S. Mazzitelli, G. Zoppei, R. Chiesa. (1997) Safe and cost-effective approach to carotid surgery. European Journal of Vascular and Endovascular Surgery 14:3, 164-169
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P SIDHU, P ALLAN. (1997) Ultrasound assessment of internal carotid artery stenosis. Clinical Radiology 52:9, 654-658
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Wilson, Peter W.F., Hoeg, Jeffrey M., D'Agostino, Ralph B., Silbershatz, Halit, Belanger, Albert M., Poehlmann, Harold, O'Leary, Daniel, Wolf, Philip A., . (1997) Cumulative Effects of High Cholesterol Levels, High Blood Pressure, and Cigarette Smoking on Carotid Stenosis. New England Journal of Medicine 337:8, 516-522
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Ali F. AbuRahma, James A. Pollack, Patrick A. Robinson, David Mullins. (1997) The reliability of color duplex ultrasound in diagnosing total carotid artery occlusion. The American Journal of Surgery 174:2, 185-187
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Peter J. Allen, Mark R. Jackson, Sean D. O’Donnell, David L. Gillespie. (1997) Saphenous vein versus polytetrafluoroethylene carotid patch angioplasty‡. The American Journal of Surgery 174:2, 115-117
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S. R. Dodds, D. Finch, A. D. B. Chant. (1997) Early effect of carotid endarterectomy on arterial blood pressure measured with an ambulatory monitor. British Journal of Surgery 84:8, 1104-1106
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Frank J. Criado, Eric Wellons, Nancy S. Clark. (1997) Evolving indications for and early results of carotid artery stenting†. The American Journal of Surgery 174:2, 111-114
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P. Cao, G. Giordano, P. De Rango, S. Caporali, M. Lenti, S. Ricci, L. Moggi. (1997) Eversion versus conventional carotid endarterectomy: A prospective study. European Journal of Vascular and Endovascular Surgery 14:2, 96-104
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G. J. Hankey. (1997) The effect of treating people with reversible ischaemic attacks of the brain and eye on the incidence of stroke in Australia. Australian and New Zealand Journal of Medicine 27:4, 420-430
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Norman R. Hertzer, Patrick J. O'Hara, Edward J. Mascha, Leonard P. Krajewski, Timothy M. Sullivan, Edwin G. Beven. (1997) Early outcome assessment for 2228 consecutive carotid endarterectomy procedures: The Cleveland Clinic experience from 1989 to 1995. Journal of Vascular Surgery 26:1, 1-10
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G. E. Mead, H. Murray, A. Farrell, P. A. O'neill, C. N. McCollum. (1997) Pilot study of carotid surgery for acute stroke. British Journal of Surgery 84:7, 990-992
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Atul Mathur, Gerald Dorros, Sriram S. Iyer, Jiri J. Vitek, Sanjay S. Yadav, Gary S. Roubin. (1997) Palmaz stent compression in patients following carotid artery stenting. Catheterization and Cardiovascular Diagnosis 41:2, 137-140
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Della M. Jarrett. (1997) The Carotid Bruit in Clinical Practice. Journal of the American Academy of Nurse Practitioners 9:6, 279-282
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Cameron M. Akbari, Frank B. Pomposelli, Gary W. Gibbons, David R. Campbell, Dorothy V. Freeman, Frank W. LoGerfo. (1997) Diabetes mellitus: A risk factor for carotid endarterectomy?. Journal of Vascular Surgery 25:6, 1070-1076
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D MOORE. (1997) Neurorehabilitation outcome in moyamoya disease*1. Archives of Physical Medicine and Rehabilitation 78:6, 672-675
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J. Baan, J.M. Thompson, G.J. Reul, D.A. Cooley, R. Brand, M.C. Henderson, J.M. van Baalen, J.H. van Bockel. (1997) Vessel wall and flow characteristics after carotid endarterectomy: Eversion endarterectomy compared with dacron patch plasty. European Journal of Vascular and Endovascular Surgery 13:6, 583-591
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I. Moseley, J. Stevens. (1997) What are the indications for a carotid duplex scan?. Clinical Radiology 52:6, 481
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Joseph R. Schneider, Julie S. Droste, John F. Golan. (1997) Carotid endarterectomy in women versus men: Patient characteristics and outcomes. Journal of Vascular Surgery 25:5, 890-898
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Beth A. Ballinger, Samuel R. Money, David M. Chatman, John C. Bowen, John L. Ochsner. (1997) Sites of Recurrence and Long-Term Results of Redo Surgery. Annals of Surgery 225:5, 512-517
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R. J. DEMPSEY, L. A. CASSIS, D. G. DAVIS, R. A. LODDER. (1997) Near-Infrared Imaging and Spectroscopy in Stroke Research: Lipoprotein Distribution and Disease. Annals of the New York Academy of Sciences 820:1 Imaging Brain, 149-169
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M.Ashraf Mansour, Steven S. Kang, William H. Baker, William C. Watson, Fred N. Littooy, Nicos Labropoulos, Howard P. Greisler. (1997) Carotid endarterectomy for recurrent stenosis. Journal of Vascular Surgery 25:5, 877-883
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Michael L. Slavin. (1997) Amaurosis fugax in the young. Survey of Ophthalmology 41:6, 481-487
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HM Lee, ERY Fu. (1997) Orbital colour Doppler imaging in chronic ocular ischaemic syndrome. Australian and New Zealand Journal of Ophthalmology 25:2, 157-163
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Douglas A. Coe, Jonathan B. Towne, Gary R. Seabrook, Julie A. Freischlag, Robert A. Cambria, Erik J. Kortbein. (1997) Duplex morphologic features of the reconstructed carotid artery: Changes occurring more than five years after endarterectomy. Journal of Vascular Surgery 25:5, 850-857
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C. Tangkanakul, C.E. Counsell, C.P. Warlow. (1997) Local versus general anaesthesia in carotid endarterectomy: a systematic review of the evidence. European Journal of Vascular and Endovascular Surgery 13:5, 491-499
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J.L Iddon, B.J Sahakian, P.J Kirkpatrick. (1997) Uncomplicated Carotid Endarterectomy Is Not Associated with Neuropsychological Impairment. Pharmacology Biochemistry and Behavior 56:4, 781-787
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Konstadinos A. Plestis, Paul Loubser, Eli M. Mizrahi, George Kantis, Zhi-Dong Jiang, Jimmy F. Howell. (1997) Continuous electroencephalographic monitoring and selective shunting reduces neurologic morbidity rates in carotid endarterectomy. Journal of Vascular Surgery 25:4, 620-628
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Stephen P. Johnson, Roy M. Fujitani, John R. Leyendecker, Frederic B. Joseph. (1997) Stent deformation and intimal hyperplasia complicating treatment of a post- carotid endarterectomy intimal flap with a Palmaz stent. Journal of Vascular Surgery 25:4, 764-768
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G NEILYATES, T BERGAMINI, S GEORGEJR, J HAMMAN, G HYDE, J DAVIDRICHARDSON. (1997) Carotid endarterectomy results from a state vascular society. The American Journal of Surgery 173:4, 342-344
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C.E. Counsell, R. Salinas, R. Naylor, C.P. Warlow. (1997) A systematic review of the randomised trials of carotid patch angioplasty in carotid endarterectomy. European Journal of Vascular and Endovascular Surgery 13:4, 345-354
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A. J. McCleary, A. F. Da Silva, P. McCollum, T. Szymanska, L. De Cossart. (1997) Prospective study of carotid endarterctomy and contralateral carotid occlusion. British Journal of Surgery 84:4, 585-586
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S.J. Fearn, A.D. Parry, A.J. Picton, A.J. Mortimer, C.N. McCollum. (1997) Should heparin be reversed after carotid endarterectomy? A randomised prospective trial. European Journal of Vascular and Endovascular Surgery 13:4, 394-397
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Charles Warlow, Peter Sandercock. (1997) Carotid endarterectomy vs carotid angioplasty. The Lancet 349:9055, 880
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Caron B. Rockman, Thomas S. Riles, Patrick J. Lamparello, Gary Giangola, Mark A. Adelman, David Stone, Claudio Guareschi, Jonathan Goldstein, Ronnie Landis. (1997) Natural history and management of the asymptomatic, moderately stenotic internal carotid artery. Journal of Vascular Surgery 25:3, 423-431
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Richard Hughes, Glenn McGuire, Walter Montanera, David Wong, Frederick J. Carmichael. (1997) Upper Airway Edema After Carotid Endarterectomy. Anesthesia & Analgesia 84:3, 475-478
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Andrea Mingoli, Paolo Sapienza, Richard J. Feldhaus, Luca di Marzo, Giovanna Sgarzini, Claudia Burchi, Claudio Modini, Antonino Cavallaro. (1997) Carotid endarterectomy in young adults: Is it a worthwhile procedure?. Journal of Vascular Surgery 25:3, 464-470
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C. M. Wittgen, MD, D. C. Brewster, MD. (1997) CURRENT STATUS OF THE SURGICAL TREATMENT OF PATIENTS WITH CAROTID ARTERY DISEASE: The Surgical Management of Carotid Atherosclerosis. Annual Review of Medicine 48:1, 69-77
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(1997) Carotid Angioplasty and Stent: An Alternative to Carotid Endarterectomy. Neurosurgery 40:2, 344-345
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G.E. Mead, P.A. O'Neill, C.N. McCollum. (1997) Is there a role for carotid surgery in acute stroke?. European Journal of Vascular and Endovascular Surgery 13:2, 112-121
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Gary M. Frydman, Catrina A. Codd, Douglas M. Cavaye, Philip J. Walker. (1997) THE PRACTICE OF CAROTID ENDARTERECTOMY IN AUSTRALASIA. ANZ Journal of Surgery 67:2-3, 103-107
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Pavel J. Levy, Jeffrey W. Olin, Marion R. Piedmonte, Jess R. Young, Norman R. Hertzer. (1997) Carotid endarterectomy in adults 50 years of age and younger: A retrospective comparative study. Journal of Vascular Surgery 25:2, 326-331
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Jack L. Cronenwett, John D. Birkmeyer, Gary B. Nackman, Mark F. Fillinger, Fritz R. Bech, Robert M. Zwolak, Daniel B. Walsh. (1997) Cost-effectiveness of carotid endarterectomy in asymptomatic patients. Journal of Vascular Surgery 25:2, 298-311
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J.F. Dyet. (1997) Endovascular stents in the arterial system — Current status. Clinical Radiology 52:2, 83-108
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P. Ridings, R. H. Morgan, G. B. Hopkinson, E. G. Shifrin. (1997) Carotid endarterectomy without angiography. British Journal of Surgery 84:1, 137-137
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Jesse E. Thompson. (1997) Carotid surgery: The past is prologue. Journal of Vascular Surgery 25:1, 131-140
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Jeffrey P. Carpenter, George A. Holland, Michael A. Golden, Clyde F. Barker, Frank J. Lexa, Maryellyn Gilfeather, Mitchell D. Schnall. (1997) Magnetic resonance angiography of the aortic arch. Journal of Vascular Surgery 25:1, 145-151
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David N. Ku. (1997) BLOOD FLOW IN ARTERIES. Annual Review of Fluid Mechanics 29:1, 399-434
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Weili Lin, Dana R. Abendschein, E. Mark Haacke. (1997) Contrast-enhanced magnetic resonance angiography of carotid arterial wall in pigs. Journal of Magnetic Resonance Imaging 7:1, 183-190
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Jerry Goldstone. (1997) Results of Randomized Trials of Carotid Endarterectomy. Journal of Vascular and Interventional Radiology 8:1, 19-22
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Bruce A. Perler. (1997) The Current Status of Carotid Endarterectomy: The “Gold Standard” Treatment for Carotid Artery Disease. Journal of Vascular and Interventional Radiology 8:1, 16-19
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G BECKER. (1997) Current and Future Treatment of Carotid Bifurcation Atherosclerotic Disease: A Perspective
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Anthony J. Comerota, Augustine R. Eze. (1996) Intraoperative high-dose regional urokinase infusion for cerebrovascular occlusion after carotid endarterectomy. Journal of Vascular Surgery 24:6, 1008-1016
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A.W. Halliday. (1996) Asymptomatic carotid stenosis — Looking for a sensible strategy. European Journal of Vascular and Endovascular Surgery 12:4, 389-390
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R SMITH, B RUTT, A FOX, R RANKIN. (1996) Geometric characterization of stenosed human carotid arteries. Academic Radiology 3:11, 898-911
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George Papanicolaou, Carla Toms, Albert E. Yellin, Fred A. Weaver. (1996) Relationship between intraoperative color-flow duplex findings and early restenosis after carotid endarterectomy: A preliminary report. Journal of Vascular Surgery 24:4, 588-596
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C. D. Irvine, A. H. Davies, P. M. Lamont, R. N. Baird. (1996) Carotid endarterectomy: An underutilized means of stroke prevention. British Journal of Surgery 83:10, 1373-1374
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F. Hansen, D. Bergqvist, B. Lindblad, M. Lindh, T. Mätzsch, T. Länne. (1996) Accuracy of duplex sonography before carotid endarterectomy — A comparison with angiography. European Journal of Vascular and Endovascular Surgery 12:3, 331-336
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H.W. Kniemeyer, A. Aulich, F. Schlachetzki, H. Steinmetz, W. Sandmann. (1996) Pseudo- and segmental occlusion of the internal carotid artery: A new classification, surgical treatment and results. European Journal of Vascular and Endovascular Surgery 12:3, 310-320
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ROB G.A. ACKERSTAFF, CEES JANSEN, FRANS L. MOLL. (1996) Carotid Endarterectomy and Intraoperative Emboli Detection.. Echocardiography 13:5, 543-550
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Walter J. McCarthy, Andrew E. Park, Esmail Koushanpour, William H. Pearce, James S. T. Yao. (1996) Carotid Endarterectomy. Annals of Surgery 224:3, 297-307
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MARIO SIEBLER, MATTHIAS SITZER, GEORG ROSE, HELMUTH STEINMETZ. (1996) Microembolism in Carotid Artery Disease. Echocardiography 13:5, 529-536
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J. Golledge, R. Wright, N. Pugh, I. F. Lane. (1996) Colour-coded duplex assessment alone before carotid endarterectomy. British Journal of Surgery 83:9, 1234-1237
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Thomas F. O'Donnell, Agustin A. Rodriguez, John E. Fortunato, Harold J. Welch, William C. Mackey. (1996) Management of recurrent carotid stenosis: Should asymptomatic lesions be treated surgically?. Journal of Vascular Surgery 24:2, 207-212
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A.J. McCleary, N.M. Dearden, D.H. Dickson, A. Watson, M.J. Gough. (1996) The differing effects of regional and general anaesthesia on cerebral metabolism during carotid endarterectomy. European Journal of Vascular and Endovascular Surgery 12:2, 173-181
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M IAFRATI, H SALAMIPOUR, C YOUNG, W MACKEY, T ODONNELLJR. (1996) Who needs surveillance of the contralateral carotid artery?. The American Journal of Surgery 172:2, 136-139
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Steven G. Katz, Roy D. Kohl. (1996) Selective use of the intensive care unit after nonaortic arterial surgery. Journal of Vascular Surgery 24:2, 235-239
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Konstadinos A. Plestis, George Kantis, Kenneth Haygood, Nan Earl, Jimmy F. Howell. (1996) Carotid endarterectomy with homologous vein patch angioplasty: A review of 1006 cases. Journal of Vascular Surgery 24:1, 109-119
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J. Moncayo, J. Bogousslavsky. (1996) Vascular dementia: persisting controversies and questions. European Journal of Neurology 3:4, 299-308
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BRUCE L. DEAN, DAVID S. LEFKOWITZ, VIRGINIA J. HOWARD, JAMES F. FREY, SKAI SCHWARTZ, LLOYD E. CHAMBLESS, JOSEPH E. HEISERMAN, WILLIAM M. FEINBERG, JAMES F. TOOLE. (1996) Comparison of Centralized Versus “Site-Based” Measurement of Angiographic Stenosis for Eligibility in the Asymptomatic Carotid Atherosclerosis Study. Investigative Radiology 31:7, 446-450
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A. Branchereau, P. Pietri, P.E. Magnan, E. Rosset. (1996) Saphenous vein bypass: An alternative to internal carotid reconstruction. European Journal of Vascular and Endovascular Surgery 12:1, 26-30
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MICHAEL R. JAFF. (1996) Carotid Endarterectomy: When and in Whom?. Journal of Interventional Cardiology 9:3, 197-199
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RANDALL T. HIGASHIDA, FONG Y. TSAI, VAN V. HALBACH, CHRISTOPHER F. DOWD, GRANT B. HIESHIMA. (1996) Transluminal Angioplasty, Thrombolysis, and Stenting for Extracranial and Intracranial Cerebral Vascular Disease. Journal of Interventional Cardiology 9:3, 245-255
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Pat O. Daily, Richard K. Freeman, Walter P. Dembitsky, Robert M. Adamson, Ricardo J. Moreno-Cabral, Stephen Marcus, Jeffrey A. Lamphere. (1996) Cost reduction by combined carotid endarterectomy and coronary artery bypass grafting. The Journal of Thoracic and Cardiovascular Surgery 111:6, 1185-1193
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Sandra Carr, Andrew Farb, William H. Pearce, Renu Virmani, James S.T. Yao. (1996) Atherosclerotic plaque rupture in symptomatic carotid artery stenosis. Journal of Vascular Surgery 23:5, 755-766
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Bruce L. Gewertz. (1996) Presidential address: Overcoming our fear of flying – Vascular surgery in the next decade. Journal of Vascular Surgery 23:5, 745-748
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P. Walleck, J. P. Becquemin, P. Desgrances, F. Bonnet. (1996) Are neurologic events occurring during carotid artery surgery predictive of postoperative neurologic complications?. Acta Anaesthesiologica Scandinavica 40:2, 167-170
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John A. Odell, Joseph L. Blackshear, Edward Davies, W. John Byrne, Christine F. Kollmorgen, William D. Edwards, Thomas A. Orszulak. (1996) Thoracoscopic obliteration of the left atrial appendage: Potential for stroke reduction?. The Annals of Thoracic Surgery 61:2, 565-569
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J.W. Norris, A.V. Alexandrov, C.F. Bladin, R. Maggisano. (1995) SPECIAL COMMUNICATION. Journal of Vascular Surgery 22:5, 637-638
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I.M. Williams, G. Mead, A.J. Picton, A. Farrell, A.J. Mortimer, C.N. McCollum. (1995) The influence of contralateral carotid stenosis and occlusion on cerebral oxygen saturation during carotid artery surgery. European Journal of Vascular and Endovascular Surgery 10:2, 198-206
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M Ashraf Mansour. (1995) Detection of total occlusion, string sign, and preocclusive stenosis of the internal carotid artery by color-flow duplex scanning. The American Journal of Surgery 170:2, 154-158
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Piergiorgio Cao, Giuseppe Giordano, Paola De Rango, Stefano Ricci, Simona Zannetti, Luigi Moggi. (1995) Carotid endarterectomy contralateral to an occluded carotid artery: A retrospective case-control study. European Journal of Vascular and Endovascular Surgery 10:1, 16-22
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David P. Archer, Timothy K. K. Tang. (1995) The choice of anaesthetic for carotid endarterectomy: does it matter?. Canadian Journal of Anaesthesia 42:7, 566-570
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Stacey B. Gross. (1995) Transient Ischemic Attacks (TIA): Current Issues in Diagnosis and Management. Journal of the American Academy of Nurse Practitioners 7:7, 329-338
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M.Ashraf Mansour, Mark A. Mattos, William E. Faught, Kim J. Hodgson, Lynne D. Barkmeier, Don E. Ramsey, David S. Sumner. (1995) The natural history of moderate (50% to 79%) internal carotid artery stenosis in symptomatic, nonhemispheric, and asymptomatic patients. Journal of Vascular Surgery 21:2, 346-357
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Wood, Alastair J.J., , Barnett, Henry J.M., Eliasziw, Michael, Meldrum, Heather E., . (1995) Drugs and Surgery in the Prevention of Ischemic Stroke. New England Journal of Medicine 332:4, 238-248
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Kistler, J. Philip, . (1994) The Risk of Embolic Stroke -- Another Piece of the Puzzle. New England Journal of Medicine 331:22, 1517-1519
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M. E. Gaunt, P. J. Martin, J. L. Smith, T. Rimmer, G. Cherryman, D. A. Ratliff, P. R. F. Bell, A. R. Naylor. (1994) Clinical relevance of intraoperative embolization detected by transcranial Doppler ultrasonography during carotid endarterectomy: A prospective study of 100 patients. British Journal of Surgery 81:10, 1435-1439
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