Carotid endarterectomy for symptomatic carotid stenosis.

@article{Rerkasem2020CarotidEF,
  title={Carotid endarterectomy for symptomatic carotid stenosis.},
  author={Amaraporn Rerkasem and Saritphat Orrapin and Dominic P.J. Howard and Kittipan Rerkasem},
  journal={The Cochrane database of systematic reviews},
  year={2020},
  volume={9},
  pages={
          CD001081
        }
}
BACKGROUND Stroke is the third leading cause of death and the most common cause of long-term disability. Severe narrowing (stenosis) of the carotid artery is an important cause of stroke. Surgical treatment (carotid endarterectomy) may reduce the risk of stroke, but carries a risk of operative complications. This is an update of a Cochrane Review, originally published in 1999, and most recently updated in 2017. OBJECTIVES To determine the balance of benefit versus risk of endarterectomy plus… 
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References

SHOWING 1-10 OF 80 REFERENCES
Carotid endarterectomy for symptomatic carotid stenosis.
TLDR
Endarterectomy was of some benefit for participants with 50% to 69% symptomatic stenosis, and highly beneficial for those with 70% to 99% stenosis without near-occlusion (moderate-quality evidence), and no benefit in people with carotid near-OCclusion (high- quality evidence).
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.
Carotid endarterectomy for symptomatic carotid stenosis.
TLDR
Carotid endarterectomy reduced the risk of disabling stroke or death for patients with stenosis exceeding ECST-measured 70% or NASCET-me measured 50%, but patients with lesser degrees of stenosis were harmed by surgery.
Clinical and angiographic predictors of stroke and death from carotid endarterectomy: systematic review
TLDR
The risk of stroke and death from carotid endarterectomy is related to several clinical and angiographic characteristics that may help clinicians to estimate operative risks for individual patients and will also facilitate more meaningful comparison of the operative risks of different surgeons or at different institutions by allowing some adjustment for differences in case mix.
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.
Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis.
TLDR
Carotid endarterectomy is highly beneficial to patients with recent hemispheric and retinal transient ischemic attacks or nondisabling strokes and ipsilateral high-grade stenosis of the internal carotid artery.
Comparison of long-term results of carotid endarterectomy for asymptomatic carotid artery stenosis
TLDR
The results of the ACST-1 study showed an equivalent effect of both treatment methods with respect to all investigated endpoints; however, the unequal sizes of the groups in addition to the statistically insufficient case numbers put a question mark on the validity of the study results.
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