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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References
Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis
Barnett Hjm.,D W Taylor,Richard Haynes,David L. Sackett,Sydney J. Peerless,Gary G. Ferguson,Allan J. Fox,R N Rankin,Vladimir Hachinski,Wiebers Do,Michael Eliasziw +10 more
TL;DR: 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.
8.3K
Interobserver agreement for the assessment of handicap in stroke patients.
TL;DR: The results confirm the value of the modified Rankin scale in the assessment of handicap in stroke patients; nevertheless, further improvements are possible.
6K
Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators.
H.J.M. Barnett,D W Taylor,Michael Eliasziw,Allan J. Fox,Gary G. Ferguson,Richard Haynes,R N Rankin,G. P. Clagett,Vladimir Hachinski,David L. Sackett,Kevin E. Thorpe,Heather Meldrum,J. D. Spence +12 more
TL;DR: 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.
3.5K
•Journal Article
Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European carotid surgery trial (ECST)
TL;DR: Carotid endarterectomy is indicated for most patients with a recent non-disabling carotid-territory ischaemic event when the symptomatic stenosis is greater than about 80%, but age and sex should also be taken into account in decisions on whether to operate.
3.3K
Protected Carotid-Artery Stenting versus Endarterectomy in High-Risk Patients
Jay S. Yadav,Mark H. Wholey,Richard E. Kuntz,Pierre B. Fayad,Barry T. Katzen,Gregory J. Mishkel,Tanvir Bajwa,Patrick L. Whitlow,Neil E. Strickman,Michael R. Jaff,Jeffrey J. Popma,David Snead,Donald E. Cutlip,Brian G. Firth,Kenneth Ouriel +14 more
TL;DR: Stenting with the use of an emboli-protection device is a less invasive revascularization strategy than endarterectomy in carotid-artery disease and among patients with severe carotidsartery stenosis and coexisting conditions, it is found that the less invasive strategy, stenting, was not inferior to endarteretomy.
2.7K
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