Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery

@article{Rothwell2004EndarterectomyFS,
  title={Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery},
  author={Pm Rothwell and Michael Eliasziw and Sa Gutnikov and C. P. Warlow and Hjm Barnett},
  journal={The Lancet},
  year={2004},
  volume={363},
  pages={915-924}
}

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References

SHOWING 1-10 OF 50 REFERENCES
Carotid endarterectomy for patients with asymptomatic internal carotid artery stenosis.
  • Medicine
    Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
  • 1995
Reanalysis of the Final Results of the European Carotid Surgery Trial
TLDR
Results of the ECST and NASCET were consistent when analyzed in the same way, and contrary to clinical recommendations and current practice, surgery was of little benefit in patients with carotid near occlusion.
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.
Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators.
TLDR
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.
The inappropriate use of carotid endarterectomy
  • H. Barnett
  • Medicine
    Canadian Medical Association Journal
  • 2004
TLDR
The procedure is indicated for patients presenting with lacunar stroke and for those with a nearly occluded internal carotid artery, but the benefit is muted, and limitations counter any potential benefit.
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.
Prediction of benefit from carotid endarterectomy in individual patients: a risk-modelling study. European Carotid Surgery Trialists' Collaborative Group.
TLDR
A prognostic score is developed to identify patients with a high risk of stroke on medical treatment but a low operative risk and risk-factor modelling could be useful to identify those patients in whom endarterectomy will be beneficial.
...
1
2
3
4
5
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