Journal Article10.1056/NEJMOA061752
Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis
Jean-Louis Mas,Gilles Chatellier,Bernard Beyssen,Alain Branchereau,Thierry Moulin,Jean-Pierre Becquemin,Vincent Larrue,Michel Lievre,Didier Leys,Jean-François Bonneville,Jacques Watelet,Jean-Pierre Pruvo,Jean-François Albucher,Alain Viguier,Philippe Piquet,Pierre Garnier,Fausto Viader,Emmanuel Touzé,Maurice Giroud,Hassan Hosseini,Jean-Christophe Pillet,Pascal Favrole,Jean-Philippe Neau,Xavier Ducrocq,S Investigators,Abstr Act +25 more
TL;DR: In this study of patients with symptomatic carotid stenosis of 60% or more, the rates of death and stroke at 1 and 6 months were lower with endarterectomy than with stenting.
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Abstract: BACKGROUND: Carotid stenting is less invasive than endarterectomy, but it is unclear whether it is as safe in patients with symptomatic carotid-artery stenosis. METHODS: We conducted a multicenter, randomized, noninferiority trial to compare stenting with endarterectomy in patients with a symptomatic carotid stenosis of at least 60%. The primary end point was the incidence of any stroke or death within 30 days after treatment. RESULTS: The trial was stopped prematurely after the inclusion of 527 patients for reasons of both safety and futility. The 30-day incidence of any stroke or death was 3.9% after endarterectomy (95% confidence interval [CI], 2.0 to 7.2) and 9.6% after stenting (95% CI, 6.4 to 14.0); the relative risk of any stroke or death after stenting as compared with endarterectomy was 2.5 (95% CI, 1.2 to 5.1). The 30-day incidence of disabling stroke or death was 1.5% after endarterectomy (95% CI, 0.5 to 4.2) and 3.4% after stenting (95% CI, 1.7 to 6.7); the relative risk was 2.2 (95% CI, 0.7 to 7.2). At 6 months, the incidence of any stroke or death was 6.1% after endarterectomy and 11.7% after stenting (P=0.02). There were more major local complications after stenting and more systemic complications (mainly pulmonary) after endarterectomy, but the differences were not significant. Cranial-nerve injury was more common after endarterectomy than after stenting. CONCLUSIONS: In this study of patients with symptomatic carotid stenosis of 60% or more, the rates of death and stroke at 1 and 6 months were lower with endarterectomy than with stenting. (ClinicalTrials.gov number, NCT00190398 [ClinicalTrials.gov].).
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2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive Summary
Thomas G. Brott,Jonathan L. Halperin,Suhny Abbara,J. Michael Bacharach,John D. Barr,Ruth L. Bush,Christopher U. Cates,Mark A. Creager,Susan B. Fowler,Gary Friday,Vicki S. Hertzberg,E. Bruce McIff,Wesley S. Moore,Peter D. Panagos,Thomas S. Riles,Robert H. Rosenwasser,Allen J. Taylor +16 more
TL;DR: Recommendations for Management of Diabetes Mellitus in Patients With Atherosclerosis of the Extracranial Carotid or Vertebral Arteries and for Control of Hyperlipidemia.
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2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American
Thomas G. Brott,Jonathan L. Halperin,Suhny Abbara,J. Michael Bacharach,John D. Barr,Ruth L. Bush,Christopher U. Cates,Mark A. Creager,Susan B. Fowler,Gary Friday,Vicki S. Hertzberg,E. Bruce McIff,Wesley S. Moore,Peter D. Panagos,Thomas S. Riles,Robert H. Rosenwasser,Allen J. Taylor,Alice K. Jacobs,Sidney C. Smith,Jeffery L. Anderson,Cynthia D. Adams,Nancy M. Albert,Christopher E. Buller,Steven M. Ettinger,Robert A. Guyton,Judith S. Hochman,Sharon A. Hunt,Harlan M. Krumholz,Frederick G. Kushner,Bruce W. Lytle,Rick A. Nishimura,E. Magnus Ohman,Richard L. Page,Barbara Riegel,William G. Stevenson,Lynn G. Tarkington,Clyde W. Yancy +36 more
Abstract: These practice consensus after a thorough review of available current scientific evidence and are intended to improve patient care. The guidelines attempt to define practices that meet the needs of most patients in most circumstances. The ultimate judgment regarding care of a particular patient must be made by the healthcare provider and patient in light of all the circumstances presented by that patient. Thus, there are situations in which deviations from these guidelines may be appropriate. Clinical decision making should consider the quality and availability of expertise in the area where care is provided. When these guidelines are used as the basis for regulatory or payer decisions, the goal should be improvement in quality of care. The Task Force recognizes that situations arise for which are patient these areas will be identified within each respective when with Protection in Patients at High Risk for Endarterectomy; and SPACE, Stent-Protected Angioplasty versus Carotid Endarterectomy.
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Percutaneous transluminal balloon angioplasty and stenting for carotid artery stenosis.
TL;DR: In patients with symptomatic carotid stenosis at standard surgical risk, endovascular treatment was associated with a higher risk of the following outcome measures occurring between randomisation and 30 days after treatment than endarterectomy: death or any stroke or myocardial infarction.
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Neurological complications of acute ischaemic stroke.
TL;DR: There is a clear need for improved surveillance and specific interventions for the prevention, early diagnosis, and proper management of neurological complications during the acute phase of stroke to reduce stroke morbidity and mortality.
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The CAPTURE registry: Predictors of outcomes in carotid artery stenting with embolic protection for high surgical risk patients in the early post-approval setting
William A. Gray,Jay S. Yadav,Patrick Verta,Andrea Scicli,Ronald M. Fairman,Mark H. Wholey,L. Nelson Hopkins,Richard Atkinson,Rod Raabe,Stanley Barnwell,Richard M. Green +10 more
TL;DR: Predictors of outcomes in carotid stenting in the earliest and largest prospective multicenter neurologist‐adjudicated experience in the United States post device approval are examined.
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