{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T09:22:28Z","timestamp":1791105748967,"version":"4.1.0"},"reference-count":17,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2000,10]]},"abstract":"<jats:p>\n            <jats:italic>Background and Purpose<\/jats:italic>\n            \u2014The Asymptomatic Carotid Atherosclerosis Study (ACAS) established the effectiveness of prophylactic carotid endarterectomy, for patients in good health who had stenosis \u226560%, if conducted by surgeons with a surgical morbidity and mortality of &lt;3%. This secondary analysis was performed to determine whether the presence of contralateral cervical carotid occlusion alters the efficacy of asymptomatic ipsilateral carotid endarterectomy.\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Methods<\/jats:italic>\n            \u2014One hundred sixty-three participants who had a baseline contralateral occlusion documented by Doppler ultrasound (77 medical, 86 surgical) were compared with 1485 participants with a patent contralateral carotid artery (748 medical, 737 surgical) for the risk of a combined end point of perioperative (30-day) death or stroke or long-term (5-year) ipsilateral stroke.\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Results<\/jats:italic>\n            \u2014For those without contralateral occlusion, surgery was associated with a 6.7% absolute reduction in the 5-year risk (95% CI, 2.1% to 11.4%), while for those with a contralateral occlusion, surgery was associated with a 2.0% absolute increase in risk (95% CI, \u22129.3% to 5.2%), which was a statistically significant difference in the effect of surgery (\n            <jats:italic>P<\/jats:italic>\n            =0.047). This difference is primarily attributable to low long-term risk for medically managed patients with contralateral occlusion.\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Conclusions<\/jats:italic>\n            \u2014While this post hoc analysis should be interpreted with caution, the findings suggest that endarterectomy in asymptomatic subjects with contralateral occlusion provides no long-term benefit (and may be harmful) in preventing stroke and death. These findings were a result of the benign course of medically treated subjects.\n          <\/jats:p>","DOI":"10.1161\/01.str.31.10.2330","type":"journal-article","created":{"date-parts":[[2011,6,17]],"date-time":"2011-06-17T20:08:03Z","timestamp":1308341283000},"page":"2330-2334","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":120,"title":["Effect of Contralateral Occlusion on Long-Term Efficacy of Endarterectomy in the Asymptomatic Carotid Atherosclerosis Study (ACAS)"],"prefix":"10.1161","volume":"31","author":[{"given":"William H.","family":"Baker","sequence":"first","affiliation":[{"name":"From the Department of Surgery, Division of Peripheral Vascular Surgery, Loyola University Medical Center, Stritch School of Medicine, Maywood, Ill (W.H.B.); Departments of Epidemiology and International Health (V.J.H.) and Biostatistics (G.H.), University of Alabama at Birmingham; and Stroke Research Center, Department of Neurology, Wake Forest University School of Medicine, Winston Salem, NC (J.F.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginia J.","family":"Howard","sequence":"additional","affiliation":[{"name":"From the Department of Surgery, Division of Peripheral Vascular Surgery, Loyola University Medical Center, Stritch School of Medicine, Maywood, Ill (W.H.B.); Departments of Epidemiology and International Health (V.J.H.) and Biostatistics (G.H.), University of Alabama at Birmingham; and Stroke Research Center, Department of Neurology, Wake Forest University School of Medicine, Winston Salem, NC (J.F.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Howard","sequence":"additional","affiliation":[{"name":"From the Department of Surgery, Division of Peripheral Vascular Surgery, Loyola University Medical Center, Stritch School of Medicine, Maywood, Ill (W.H.B.); Departments of Epidemiology and International Health (V.J.H.) and Biostatistics (G.H.), University of Alabama at Birmingham; and Stroke Research Center, Department of Neurology, Wake Forest University School of Medicine, Winston Salem, NC (J.F.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James F.","family":"Toole","sequence":"additional","affiliation":[{"name":"From the Department of Surgery, Division of Peripheral Vascular Surgery, Loyola University Medical Center, Stritch School of Medicine, Maywood, Ill (W.H.B.); Departments of Epidemiology and International Health (V.J.H.) and Biostatistics (G.H.), University of Alabama at Birmingham; and Stroke Research Center, Department of Neurology, Wake Forest University School of Medicine, Winston Salem, NC (J.F.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"for the ACAS","family":"Investigators","sequence":"additional","affiliation":[{"name":"From the Department of Surgery, Division of Peripheral Vascular Surgery, Loyola University Medical Center, Stritch School of Medicine, Maywood, Ill (W.H.B.); Departments of Epidemiology and International Health (V.J.H.) and Biostatistics (G.H.), University of Alabama at Birmingham; and Stroke Research Center, Department of Neurology, Wake Forest University School of Medicine, Winston Salem, NC (J.F.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_1_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1995.03520420037035"},{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/str.20.7.2665205"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1997.03550170062033"},{"key":"e_1_3_2_4_2","unstructured":"Kalbfleisch JD Prentice RL. 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