Results of Trials for Symptomatic Carotid Stenosis

The European Carotid Surgery Trial (ECST) enrolled patients with mild (less than 30% stenosis), moderate (30-69% stenosis) and severe (70-99% stenosis) carotid stenosis and randomized them into a non-surgical group and a surgical group [17]. Among 374 randomized patients with mild stenosis, there was no difference in the risk of ipsilateral stroke between groups. Among those patients with severe stenosis, surgery proved beneficial in preventing stroke. A 7.5% risk of ipsilateral stroke or death within 30 days of surgery was found but, in follow-up at 3 years, the surgery group had an additional 2.8% risk of stroke compared with 16.8% risk for the non-surgical group. The risk of death or ipsilateral disabling stroke was reduced from 11% in the non-surgery group to 6% in the surgery group.

In the North American Symptomatic Carotid Endarterectomy Trial (NASCET), 659 patients with greater than 70% stenosis were randomized to surgical and non-surgical treatment [18]. At a mean follow-up of 24 months, ipsilateral stroke was noted in 26% of non-surgical patients compared to 9% of patients treated with endarterectomy. This trial was prematurely stopped as a result of the overwhelming risk reduction (17%) observed in the surgical group. The benefits of surgery were seen on a variety of outcomes, including major stroke, major stroke and death, and functional disability.

The Veterans Administration Symptomatic Stenosis Trial (VASST) [19] enrolled a total of 193 men aged 35-82 years. These were then randomized to a surgery group (n = 91) and a nonsurgical group (n = 98). Although this study was also terminated prematurely as a result of the NASCET study findings, analysis demonstrated a significant reduction in ipsilateral stroke and crescendo TIAs for patients who had greater than 50% stenosis, two-thirds of whom demonstrated greater than 70% stenosis of their ICA by angiography. There was a risk reduction of 11.7% in the surgical group when compared to the non-surgical group. It was also observed that the greatest benefit was seen in patients who presented with hemispheric TIA rather than transient monocular blindness, although the difference was not statistically significant.

Cure Your Yeast Infection For Good

Cure Your Yeast Infection For Good

The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

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