Endarterectomy for moderate symptomatic carotid stenosis: interim results from the MRC European Carotid Surgery Trial

Lancet. 1996 Jun 8;347(9015):1591-3.


Background: The objective of this study was to assess whether carotid endarterectomy is an appropriate treatment for patients with recent cerebrovascular events in the territory supplied by a moderately stenosed (30-69%) internal carotid artery. Results have previously been reported for severe (70-99%) and mild (0-29%) stenosis.

Methods: A multicentre randomised controlled trial recruited 1599 patients with moderate stenosis treated in 97 hospitals from 15 countries. 60% of patients were allocated to receive and 40% to avoid carotid endarterectomy. The analysis was by intention to treat.

Findings: Nine patients were omitted from the analysis because no follow-up data were received. Stroke-free life expectancy (curtailed at 8 years) was shorter in the surgery patients than in the non-surgery control groups (patients with 30-49% stenosis, life expectancy = 6.16 years [controls: 6.63 years]; patients with 50-69% stenosis, life expectancy = 5.93 [6.14] years). It remains possible that patients might derive some benefit from surgery in the very long term; however, our data show that no benefit would be gained over a period of < 4-5 years in patients with 50-69% stenosis and < 6-7 years in patients with 30-49% stenosis.

Interpretation: Previous interim results from this study showed that surgery is beneficial in patients with severe stenosis but harmful in those with mild stenosis. With more randomised patients and longer follow-up, the study now shows that endarterectomy is not indicated for most, possibly all, patients with moderate symptomatic carotid stenosis.

Publication types

  • Clinical Trial
  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Carotid Artery, Internal
  • Carotid Stenosis / mortality
  • Carotid Stenosis / surgery*
  • Cerebrovascular Disorders / epidemiology
  • Cerebrovascular Disorders / prevention & control*
  • Contraindications
  • Disease-Free Survival
  • Endarterectomy, Carotid*
  • Europe / epidemiology
  • Follow-Up Studies
  • Humans
  • Life Expectancy
  • Male
  • Middle Aged
  • Time Factors
  • Treatment Outcome