Antiplatelet therapy following carotid bifurcation endarterectomy. Evaluation of a controlled clinical trial. Prognostic significance of histologic plaque examination on behalf of survival

Eur J Vasc Surg. 1990 Jun;4(3):285-9. doi: 10.1016/s0950-821x(05)80209-9.


To determine whether antiplatelet therapy following carotid bifurcation endarterectomy influences postoperative survival and whether signs of progression in the plaques harvested at the time of surgery might be a prognostic indicator, a controlled clinical trial was undertaken. During 1982 to 1985, 66 patients were recruited, operated on (carotid endarterectomy) and assigned, using the method of adaptive randomisation to the therapy group (n = 32) receiving 1.0 g acetylsalicylic acid (ASA) per day, starting day two prior to surgery, or to the control group (n = 34), which remained without antiplatelet medication. The plaques harvested at the time of surgery were processed using standard histopathological methods and examined "blindly" by light microscopy for signs of arterio-sclerotic progression. The final endpoint was patient survival. The last assessment of the participants survival status was done by June 1989. During follow-up, 20 patients died, six in the treatment group and 14 in the untreated group, the difference being statistically significant (P less than 0.013 Breslow, P less than 0.029 Mantel). In 27 instances the histo-pathological examination showed signs of progression. In this subgroup ASA yielded a significant prolongation of patient survival (P less than 0.017 Breslow, P less than 0.048 Mantel). In the remaining patients no signs of cellular infiltration were evident and no influence of ASA on patient survival was demonstrable (P less than 0.503 Breslow, P less than 0.390 Mantel).

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Aspirin / therapeutic use*
  • Carotid Arteries / pathology
  • Carotid Artery Diseases / mortality
  • Carotid Artery Diseases / pathology
  • Carotid Artery Diseases / therapy*
  • Endarterectomy*
  • Female
  • Follow-Up Studies
  • Humans
  • Intracranial Arteriosclerosis / mortality
  • Intracranial Arteriosclerosis / pathology
  • Intracranial Arteriosclerosis / therapy*
  • Male
  • Middle Aged
  • Postoperative Care
  • Prospective Studies
  • Randomized Controlled Trials as Topic
  • Time Factors


  • Aspirin