Document Detail


How I interpreted the randomised trials of carotid angioplasty/stenting versus endarterectomy.
MedLine Citation:
PMID:  18485759     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Carotid endarterectomy (CEA) for carotid stenosis is effective in preventing ipsilateral carotid territory ischaemic stroke. Paradoxically however, it causes a stroke (the event it is trying to prevent) in about 5% or more of cases. If carotid angioplasty/stenting (CAS) is to have a place in the management of patients with carotid stenosis (beyond those who are not suitable for CEA), it has to demonstrate that it is also effective and safe. Limited data from 12 randomised trials comparing CAS with CEA (the current "gold standard") in a total of 3227 patients with carotid stenosis (90% symptomatic) question the safety of CAS and suggest that it may cause more non-fatal, procedural strokes than CEA despite similar mortality rates and a much lower immediate local complication rate (eg cranial neuropathy). However, the published trials are rather heterogeneous (clinically and methodologically), none is large enough to provide robust and convincing data and long-term follow-up is very limited. Accordingly, it remains unknown whether CAS is effective in preventing recurrent stroke among patients with carotid stenosis, or whether it is safe. More data (from at least another 3,000 patients) are needed from the ongoing randomised trials before it can reliably be concluded whether CAS is inferior to, non-inferior to, or more effective than, CEA. More importantly, it will be possible to determine which patients should be treated preferentially with CAS, which patients with CEA, and which patients should not undergo either revascularisation procedure.
Authors:
Graeme J Hankey
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Publication Detail:
Type:  Journal Article     Date:  2008-05-15
Journal Detail:
Title:  European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery     Volume:  36     ISSN:  1532-2165     ISO Abbreviation:  Eur J Vasc Endovasc Surg     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-06-27     Completed Date:  2008-07-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9512728     Medline TA:  Eur J Vasc Endovasc Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  34-40     Citation Subset:  IM    
Affiliation:
Stroke Unit, Department of Neurology, Royal Perth Hospital, Perth, Australia. gjhankey@cyllene.uwa.edu.au
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MeSH Terms
Descriptor/Qualifier:
Angioplasty / adverse effects,  instrumentation*
Carotid Stenosis / complications,  surgery*
Endarterectomy, Carotid* / adverse effects
Evidence-Based Medicine
Humans
Meta-Analysis as Topic
Patient Selection
Randomized Controlled Trials as Topic
Risk Assessment
Stents*
Stroke / etiology,  prevention & control*
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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