CLINICAL EPIDEMIOLOGYCarotid Endarterectomy Benefits Patients with CKD and Symptomatic High-Grade StenosisMathew, Anna*; Eliasziw, Michael†; Devereaux, P.J.‡,§; Merino, Jose G.‖; Barnett, Henry J.M.¶,**; Garg, Amit X.*,‡,†† for the North American Symptomatic Carotid Endarterectomy Trial (NASCET) Collaborators Author Information *Division of Nephrology, ¶Department of Clinical Neurological Sciences, **John P. Robarts Research Institute, ††Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada; †Department of Medicine, Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Departments of ‡Clinical Epidemiology and Biostatistics and §Medicine, McMaster University, Hamilton, Ontario, Canada; and ‖Section on Stroke Diagnostics and Therapeutics, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland Correspondence: Dr. Amit Garg, London Kidney Clinical Research Unit, Room ELL-101, Westminster, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario N6A 4G5. Phone: 519-685-8502; Fax: 519-685-8072; E-mail: [email protected] Received March 15, 2009 Accepted August 28, 2009 Journal of the American Society of Nephrology 21(1):p 145-152, January 2010. | DOI: 10.1681/ASN.2009030287 Buy Metrics Abstract Endarterectomy is generally recommended for symptomatic high-grade (70 to 99%) stenosis of the internal carotid artery, but whether this procedure is beneficial among patients with chronic kidney disease (CKD) is unknown. In this re-analysis of data from the North American Symptomatic Carotid Endarterectomy Trial, we included patients with symptomatic stenosis and either stage 3 CKD (n = 524) or preserved kidney function (n = 966; estimated GFR ≥ 60). For medically treated patients with high-grade stenosis, risk for ipsilateral stroke at 2 yr was significantly higher in patients with CKD than in those with preserved renal function (31.6 versus 19.3%; P = 0.042); carotid endarterectomy significantly reduced this risk by 82 and 51%, respectively. To prevent one ipsilateral stroke, the number needed to treat by endarterectomy was four for patients with CKD and 10 for patients with preserved renal function. Compared with patients with preserved renal function, those with CKD had similar rates of perioperative stroke and death but higher rates of cardiac events. In conclusion, patients with stage 3 CKD and symptomatic high-grade carotid stenosis gain a large benefit in stroke risk reduction after endarterectomy. Copyright © 2010 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.