Document Detail

Urgent carotid endarterectomy for patients with unstable symptoms: systematic review and meta-analysis of outcomes.
MedLine Citation:
PMID:  19769803     Owner:  NLM     Status:  MEDLINE    
Current evidence suggests that carotid endarterectomy (CEA) performed within 2 weeks of symptoms produces better long-term results than if it is delayed. Urgent endarterectomy following unstable presentations such as crescendo transient ischemic attack (cTIA) or progressive stroke has been associated with variable results. The evidence for this treatment strategy required reviewing. A systematic review of articles related to urgent CEA between 1980 and 2008 was performed. For cTIA, there was an odds ratio of 5.6 (95% confidence interval 3.3-9.7, p < or = .0001) for combined stroke or death compared with surgery for "standard" indications. For unstable stroke, the odds ratio was 5.5 (95% confidence interval 3.1-9.3, p < or = .0001). Patients with unstable neurologic presentations are at higher risk of complications if operated on urgently. Clearer definitions would help more precise patient selection to avoid inadvertently operating on patients with an unacceptably high risk of poor outcome.
Benjamin O Patterson; Peter J Holt; Robert J Hinchliffe; Matt M Thompson; Ian M Loftus
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Review    
Journal Detail:
Title:  Vascular     Volume:  17     ISSN:  1708-5381     ISO Abbreviation:  Vascular     Publication Date:    2009 Sep-Oct
Date Detail:
Created Date:  2009-09-22     Completed Date:  2009-11-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101196722     Medline TA:  Vascular     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  243-52     Citation Subset:  IM    
Department of Vascular Surgery, St George's Vascular Institute, St James' Wing, St George's Hospital, Tooting, London, UK.
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MeSH Terms
Carotid Stenosis / complications,  surgery*
Endarterectomy, Carotid / adverse effects*
Ischemic Attack, Transient / etiology,  surgery
Patient Selection
Stroke / etiology,  surgery
Treatment Outcome

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

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