Circulation. 1998;97:501-509
(Circulation. 1998;97:501-509.)
© 1998 American Heart Association, Inc.
Guidelines for Carotid Endarterectomy
A Statement for Healthcare Professionals From a Special Writing Group of the Stroke Council, American Heart Association
José Biller, MD, Chair;
William M. Feinberg, MD1;
John E. Castaldo, MD;
Anthony D. Whittemore, MD;
Robert E. Harbaugh, MD;
Robert J. Dempsey, MD;
Louis R. Caplan, MD;
Timothy F. Kresowik, MD;
David B. Matchar, MD;
James F. Toole, MD;
J. Donald Easton, MD;
Harold P. Adams, Jr, MD;
Lawrence M. Brass, MD;
Robert W. Hobson, II, MD;
Thomas G. Brott, MD;
; Linda Sternau, MD
Key Words: AHA Medical/Scientific Statements • stroke • carotid arteries • carotid endarterectomy
Since the 1950s carotid endarterectomy has been performed
in patients with symptomatic carotid artery
stenosis, based on suggestive but inconclusive evidence for its
effectiveness. Only during the last 5 years have randomized studies
clarified the indications for surgery. In preparing this report, panel
members used the same rules of evidence used in the previous
report1 2 (Table
).
View this table:
[in this window]
[in a new window]
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Table 1. Levels of Evidence and Grading of
Recommendations
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Management of Risk Factors
Few studies have analyzed control of risk factors in a
randomized, prospective manner following carotid
endarterectomy. However, a wealth of data are
available regarding the general relationship between risk factor
control and stroke risk. These data provide some guidance for the care
of endarterectomy patients.
Hypertension
Hypertension is the most powerful, prevalent, and treatable risk
factor for stroke.3 Both systolic and
diastolic blood pressure are independently related to
stroke incidence. Isolated systolic hypertension, which is
common in the elderly, also considerably increases risk of stroke.
Reduction of elevated blood pressure significantly lowers risk of
stroke. Meta-analyses of randomized trials found that an
average reduction in diastolic blood pressure of 6
mm Hg produces a 42% reduction in stroke
incidence.3 4 Treatment of isolated
systolic hypertension in people older than 60 years also
reduces stroke incidence by 36% without an excessive number of side
effects such as depression or dementia.5
Long-term care of patients after endarterectomy
should include careful control of hypertension (Grade A recommendation
for treatment of hypertension in general; Grade C recommendation for
postendarterectomy care).
Perioperative treatment of hypertension after carotid
endarterectomy represents a special
. . . [Full Text of this Article]
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