Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis.
Background: Endarterectomy reduces risk of stroke in certain patients with recently symptomatic internal carotid stenosis. However, investigators have made different recommendations about the degree of stenosis above which surgery is effective, partly because of differences between trials in the met...
| Published in: | Lancet Vol. 361; no. 9352; pp. 107 - 117 |
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| Main Authors: | , , , , , , , , , , , , , , , |
| Format: | diagnostic images pictorial research tables/charts Journal Article |
| Published: |
Lancet
1/11/2003
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106861543&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 106861543 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 01406736 LAN jtl: Lancet issn: 01406736 maglogo: N pubinfo: dt: 1/11/2003 vid: 361 iid: 9352 pid: 1297 pub: Lancet place: Philadelphia, Pennsylvania artinfo: ui: 106861543 106861543 NLM12531577 2003108483 10.1016/s0140-6736(03)12228-3 NLM12531577 106861543 ppf: 107 ppct: 10 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. aug: au: Rothwell PM Eliasziw M Gutnikov SA Fox AJ Taylor DW Mayberg MR Warlow CP Barnett HJM Rothwell, P M Eliasziw, M Gutnikov, S A Fox, A J Taylor, D W Mayberg, M R Warlow, C P Barnett, H J M affil: Stroke Prevention Research Unit, University Department of Clinical Neurology, Radcliffe Infirmary, Oxford, UK sug: subj: Carotid Stenosis Surgery Endarterectomy Stroke Mortality Aged Carotid Stenosis Physiopathology Carotid Stenosis Radiography Confidence Intervals Funding Source Human Kaplan-Meier Estimator Meta Analysis Middle Age Randomized Controlled Trials Relative Risk Survival Analysis Aged: 65+ years Middle Aged: 45-64 years ab: Background: Endarterectomy reduces risk of stroke in certain patients with recently symptomatic internal carotid stenosis. However, investigators have made different recommendations about the degree of stenosis above which surgery is effective, partly because of differences between trials in the methods of measurement of stenosis. To accurately assess the overall effect of surgery, and to increase power for secondary analyses, we pooled trial data and reassessed carotid angiograms.Methods: We pooled data from the European Carotid Surgery Trial (ECST), North American Symptomatic Carotid Endarterectomy Trial, and Veterans Affairs trial 309 from the original electronic data files. Outcome events were re-defined, if necessary, to achieve comparability. Pre-randomisation carotid angiograms from ECST were re-measured by the method used in the other two trials.Results: Risks of main outcomes in both treatment groups and effects of surgery did not differ between trials. Data for 6092 patients, with 35000 patient-years of follow-up, were therefore pooled. Surgery increased the 5-year risk of ipsilateral ischaemic stroke in patients with less than 30% stenosis (n=1746, absolute risk reduction -2.2%, p=0.05), had no effect in patients with 30-49% stenosis (1429, 3.2%, p=0.6), was of marginal benefit in those with 50-69% stenosis (1549, 4.6%, p=0.04), and was highly beneficial in those with 70% stenosis or greater without near-occlusion (1095, 16.0%, p<0.001). There was a trend towards benefit from surgery in patients with near-occlusion at 2 years' follow-up (262, 5.6%, p=0.19), but no benefit at 5 years (-1.7%, p=0.9).Interpretation: Re-analysis of the trials with the same measurements and definitions yielded highly consistent results. Surgery is of some benefit for patients with 50-69% symptomatic stenosis, and highly beneficial for those with 70% symptomatic stenosis or greater but without near-occlusion. Benefit in patients with carotid near-occlusion is marginal in the short-term and uncertain in the long-term. pubtype: Academic Journal doctype: diagnostic images pictorial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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