Document Detail


A study of 510 carotid endarterectomies and a review of the recent carotid endarterectomy trials.
MedLine Citation:
PMID:  11558289     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The release of several randomized trials comparing carotid endarterectomy (CEA) to other methods of stroke prevention in the early 1990s established CEA as the "gold standard" in the prevention of stroke from carotid occlusive disease. This study examines 510 of the CEAs performed by the first author at Charleston Area Medical Center in Charleston, W. Va., from 1991-99, which were part of three prospective randomized CEA trials at CAMC. All patients were observed clinically and underwent postoperative color duplex ultrasound scans at 30 days, six months, 12 months, and every year thereafter to assess the presence of recurrent stenoses. The overall perioperative stroke rate in the whole series was 2.7% (14/510). The incidence of perioperative ipsilateral stroke was 4.6% for CEA with primary closure vs. 1.9% for CEA with patching (p < 0.05). Patching using PTFE or vein patch closure had the lowest incidence of perioperative stroke rate (0.7%). Primary closure had a statistically significant higher incidence of recurrent stenoses than PTFE or vein patch closure (28% vs. 2.9%, p < 0.0001). The incidence of ipsilateral stroke and recurrent stenosis using the Hemashield patch was higher than either PTFE or vein patch closure. As the indications for CEA expand, the safety, utility, and cost-effectiveness of the procedure must be closely monitored at each institution. However, as shown in this study, CEA (using PTFE or vein patch closure) is a safe, effective, and well-established tool in the treatment of stroke in the 21st century.
Authors:
A F AbuRahma; R S Hannay
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Publication Detail:
Type:  Comparative Study; Journal Article; Review    
Journal Detail:
Title:  The West Virginia medical journal     Volume:  97     ISSN:  0043-3284     ISO Abbreviation:  W V Med J     Publication Date:    2001 Jul-Aug
Date Detail:
Created Date:  2001-09-17     Completed Date:  2001-10-11     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0413777     Medline TA:  W V Med J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  197-200     Citation Subset:  IM    
Affiliation:
Robert C. Byrd Health Sciences Center West Virginia University, Charleston Division, Vascular Laboratory, Charleston Area Medical Center, Charleston, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Carotid Stenosis / epidemiology,  surgery*,  ultrasonography
Endarterectomy / methods*,  mortality
Female
Humans
Incidence
Male
Middle Aged
Prognosis
Randomized Controlled Trials as Topic
Risk Factors
Sensitivity and Specificity
Stroke / prevention & control*
Survival Analysis
Ultrasonography, Doppler
Virginia / epidemiology

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


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