Influence of aspirin in the management of asymptomatic carotid artery stenosis

Abstract Purpose:  Aspirin therapy is recommended commonly for symptomatic extracranial carotid artery occlusive disease. However, its role in the management of asymptomatic carotid artery stenosis has not been reported previously. Methods:  In 11 clinical centers during the period 1983 to 1991, 444 adult male patients with significant asymptomatic carotid artery stenosis (≥50% arteriographically) were randomized to receive optimal medical management including aspirin plus carotid endarterectomy ( n = 211) or optimal medical management alone ( n = 233). At the conclusion of the study (mean follow-up time 47.9 months), at the time of a patient's death, or at occurrence of a neurologic end point, 16% of patients ( n = 72) were not taking any aspirin, 51% ( n = 226) had been converted to receiving enteric-coated aspirin, and only 33% ( n = 146) were taking plain aspirin (27% at reduced dosage). Among patients from the medical group, 37 (16%) of 233 were not taking any aspirin and formed the basis for this retrospective analysis of the group for which no control population was available. Results:  Mortality rates in this group were not significantly different for patients not taking aspirin as compared with the rates for those taking aspirin, although patients not taking aspirin had a higher incidence of myocardial infarction (27%) as compared with patients taking aspirin (8%), p p > 0.05; stroke and transient ischemic attack, 37.8% and 17.3%, p Conclusion:  These data suggest that patients with significant asymptomatic carotid artery stenosis who are intolerant of aspirin have a higher incidence of neurologic events than those patients able to tolerate the drug. (J VASC SURG 1993;17:257-65.)