| Reflections by contrarians on the post-CREST evaluation of carotid stenting for stroke prevention. | |
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MedLine Citation:
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PMID: 21050401 Owner: NLM Status: In-Process |
Abstract/OtherAbstract:
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Carotid angioplasty and stenting has become a popular alternative to carotid endarterectomy for the treatment of carotid stenosis in stroke. Evidence from early randomized controlled trials comparing these interventions revealed mixed results. The largest such trial, the Carotid Revascularization Endarterectomy vs. Stenting Trial recently showed equivalence of the procedures in a mixed cohort of both symptomatic and asymptomatic patients. These results have been heralded in North America as definitively demonstrating the safety and efficacy of carotid angioplasty and stenting, making it an attractive alternative to carotid endarterectomy. It is therefore probable that many more asymptomatic patients will be subjected to Carotid angioplasty and stenting, perceived by many to be less invasive than carotid endarterectomy. The authors argue that the design of Carotid Revascularization Endarterectomy vs. Stenting Trial was flawed by the mixture of two dissimilar patient groups, thus violating the principle of ceteris paribus, essential for the validity of a randomized controlled trials. The evidence for any invasive treatment of asymptomatic carotid disease is weak, with recent data favouring purely medical management. The authors believe that carotid angioplasty and stenting in asymptomatic patients should cease until better evidence is available. |
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Authors:
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Henry J M Barnett; David M Pelz; Stephen P Lownie |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: International journal of stroke : official journal of the International Stroke Society Volume: 5 ISSN: 1747-4949 ISO Abbreviation: Int J Stroke Publication Date: 2010 Dec |
Date Detail:
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Created Date: 2010-11-05 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101274068 Medline TA: Int J Stroke Country: England |
Other Details:
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Languages: eng Pagination: 455-6 Citation Subset: IM |
Copyright Information:
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© 2010 The Authors. International Journal of Stroke © 2010 World Stroke Organization. |
Affiliation:
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Robarts Research Institute, University of Western Ontario, London, ON, Canada. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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