Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis

@article{Rothwell2003AnalysisOP,
  title={Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis},
  author={Pm Rothwell and Michael Eliasziw and Sa Gutnikov and Aj Fox and DW Taylor and Marc R. Mayberg and C. P. Warlow and Hjm Barnett},
  journal={The Lancet},
  year={2003},
  volume={361},
  pages={107-116}
}
Carotid endarterectomy for symptomatic carotid stenosis.
TLDR
Benefit from surgery was greatest in men, patients aged 75 years or over, and patients randomised within two weeks after their last ischaemic event and fell rapidly with increasing delay, while benefit in patients with carotid near-occlusion is marginal in the short-term and uncertain in the long-term.
Time Trends in the Published Risks of Stroke and Death due to Endarterectomy for Symptomatic Carotid Stenosis
TLDR
A systematic review of all studies published between 1994 and 2001 inclusive that reported the risks of stroke and death for symptomatic carotid stenosis, and compared the reported risks and patient characteristics with those in the ECST and NASCET and with the previous review of studies published prior to 1995 found no evidence of a systematic reduction.
Carotid artery stenosis : surgical aspects.
TLDR
This extensively validated national audit of CEA for patients with asymptomatic carotid artery stenosis showed results well comparable with those of the randomized trials, and improved over time.
Overview of the principal results and secondary analyses from the European and North American randomised trials of endarterectomy for symptomatic carotid stenosis.
  • A. Naylor, P. Rothwell, P. Bell
  • Medicine
    European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
  • 2003
TLDR
Surgeons must quote their own results and be aware that a high operative risk reduces long-term benefit, in those centres with a higher operative death/stroke rate, some "lower risk" patients should probably be considered for best medical therapy alone.
Risk of Stroke before Revascularisation in Patients with Symptomatic Carotid Stenosis: A Pooled Analysis of Randomised Controlled Trials.
  • U. Fisch, S. von Felten, L. Bonati
  • Medicine
    European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
  • 2021
Carotid artery stenosis—an evidence-based review of surgical and non-surgical treatments
TLDR
The results from four large randomised controlled trials comparing the two modalities suggest a marginally better outcome for carotid endarterectomy compared with angioplasty in terms of perioperative mortality and stroke, though the results of further studies are awaited.
How I interpreted the randomised trials of carotid angioplasty/stenting versus endarterectomy.
  • G. Hankey
  • Medicine
    European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
  • 2008
The safety of carotid artery surgery and stenting
TLDR
Which baseline patient characteristics, processes of care or vascular anatomical variants are associated with risk of stroke, myocardial infarction (MI) or death within 30 days of either procedure, and whether existing models to predict the risk of these complications performed well in ICSS patients are determined.
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Adjusting for primary endpoints and duration of follow-up, carotid endarterectomy has a similar benefit for symptomatic patients across trials and a same benefit for men and women.
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The disappointing correlation found between the measurement of the percentage of stenosis in the arteriograms and in the ultrasound studies will narrow when all institutions performing endarterectomy are employing state-of-the-art color-flow duplex sonographic equipment.
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The sample size was set at 1,900 patients, with continuing enrollment, and the characteristics of the type of symptomatic patient in this study were similar to those randomized so that the conclusions about the benefit of carotid endarterectomy can be generalized.
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Benefit of carotid endarterectomy was greatest among men, patients with recent stroke as the qualifying event, and patients with hemispheric symptoms, and decisions about treatment for patients in this category must take into account recognized risk factors.
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