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3%, respectively). 4% improvement in clinical outcome (assessed by a modified Rankin score [mRS] of 0 or 1) and a 16% reduction in mortality at 90 days, although neither change was statistically significant. 4% of hemorrhages were symptomatic (defined as a decline in neurologic status). 7% after the investigators reduced the dose of heparin being used. 8 to 40%. PROACT II (1999, Nϭ180)17 The PROACT II study, which was enrolling at the time the results of PROACT were published, was a multicenter, prospective, randomized control trial that primarily aimed at assessing the neurologic outcome of the use of IA pro-UK in the treatment of MCA strokes.

In contrast to the excellent long-term data for CEA, long-term stroke-free survival data for CAS do not currently exist. 18 Two trials examining CAS versus CEA have been stopped as a result of safety concerns associated with CAS. There is a small subset of patients with anatomic criteria for which CAS has a clear benefit (Table 3–2) and includes patients with previous neck surgery, such as a tracheostomy or radical neck dissection. Patients with previous radiation exposure or extensive infection are also more likely to have a difficult operative field secondary to scarring and adhesions and consequently may suffer a cranial nerve injury.

19. Karp HR, Flanders WD, Shipp CC, et al. Carotid endarterectomy among medicare beneficiaries: A statewide evaluation of appropriateness and outcome. Stroke 1998;29:46–52. 20. Healthcare Cost and Utilization Project (HCUP) Quality Control Procedures. http://www. jsp Accessed January 2, 2008. 21. Eagle KA, Guyton RA, Davidoff R, et al. ACC/AHA guidelines for coronary artery bypass graft surgery: executive summary and recommendations: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to revise the 1991 guidelines for coronary artery bypass graft surgery).

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