Carotid Angioplasty and Stenting versus Carotid Endarterectomy for Treatment of Asymptomatic Carotid Stenosis: A Randomized Trial in a Community Hospital

Brooks, William H.; McClure, Rick; Jones, Michael R.; Coleman, Timothy L; Breathitt, Linda

doi:10.1227/01.neu.0000103447.30087.d3

Cited by 215 publications

(167 citation statements)

References 54 publications

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“…Patients with a carotid stenosis Ͼ80% and no symptoms or signs of cerebral ischemia were randomized between stenting and surgery (nϭ84 patients). 12 No events occurred in these patients.…”

Section: Kentuckymentioning

confidence: 81%

“…Five of these were completed randomized controlled trials comparing endovascular treatment of carotid stenosis with surgery (nϭ879 patients) 3,[11][12][13][14] ; the 5 other trials were stopped early (nϭ2299 patients). [15][16][17][18][19] …”

Section: Resultsmentioning

confidence: 99%

“…11,12 The first trial compared carotid angioplasty and stenting with endarterectomy in 104 patients who had experienced symptoms or signs of cerebral ischemia confined to the ipsilateral carotid artery within the previous 3 months and with an ipsilateral carotid stenosis of greater than 70% (measured by NASCET criteria). 11 One patient died of myocardial infarction immediately after carotid endarterectomy.…”

Section: Kentuckymentioning

confidence: 99%

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Randomized Controlled Trials Comparing Endarterectomy and Endovascular Treatment for Carotid Artery Stenosis

Ederle

Featherstone

Brown

2009

Stroke

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Background and Purpose-Endovascular treatment of carotid stenosis may be an alternative to surgical endarterectomy.We conducted a systematic review of the randomized evidence to assess the benefits and risks of endovascular treatment compared to surgery. Methods-Cochrane registers and online databases were searched and researchers in the field contacted. Outcome events were compared using odds ratios (ORs) calculated using the Peto fixed effect and Mantel-Haenszel random effects models if there was significant heterogeneity.

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Section: Kentuckymentioning

confidence: 81%

Section: Resultsmentioning

confidence: 99%

Section: Kentuckymentioning

confidence: 99%

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Randomized Controlled Trials Comparing Endarterectomy and Endovascular Treatment for Carotid Artery Stenosis

Ederle

Featherstone

Brown

2009

Stroke

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“…However, so far there has been no evidence of CAS superiority over CEA. [6][7][8][9][10][11][12][13] In Brazil, practice of carotid surgery has more than 40 years, and a survey has been published about indications and about who would indicate that procedure: neurologists, cardiologists or vascular surgeons.…”

Section: Introductionmentioning

confidence: 99%

Análise crítica das indicações e resultados do tratamento cirúrgico da doença carotídea

Bonamigo

Lucas

2007

J. vasc. bras.

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O tratamento da doença carotídea tem ganhado enfoque nos últimos anos, principalmente com o advento da técnica endovascular, que defende o emprego da angioplastia e stent de carótida (CAS), principalmente em pacientes considerados de "alto risco" para a endarterectomia carotídea (ECA). Através da revisão bibliográfica, analisamos os resultados do tratamento da lesão carotídea em ambas as técnicas, realizando comentários embasados na experiência pessoal e nos dados da literatura, sobretudo nos pacientes de alto risco. Até o presente momento, não há evidência e justificativa para o emprego da CAS em larga escala nos pacientes com doença carotídea, inclusive nas situações de alto risco, tais como nos octogenários. No entanto, acreditamos que a CAS possa ser um coadjuvante no tratamento de pequeno número de pacientes com lesão carotídea (até 4% dos casos), como na presença de pescoço hostil, radioterapia prévia e alguns casos de estenose carotídea alta. Quando realizada com os cuidados técnicos necessários, a ECA ainda continua a melhor opção terapêutica aos doentes com lesão carotídea.

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“…30 A follow-up randomized trial of over 80 asymptomatic patients demonstrated similarly equivalent very low rates of complications in either arm. 31 The largest study so far (CAVATAS) 32 consisted mainly of carotid balloon angioplasty (74%) with a small number of implanted stents and randomized over 500 patients to CEA or endovascular therapy. It showed a periprocedural rate of stroke and death of approximately 10%, which was similar for both arms, but much higher than NASCET's rate.…”

Section: Early Randomized Studiesmentioning

confidence: 99%

Endarterectomy and Stenting for Asymptomatic Carotid Stenosis

Fayad

2007

Stroke

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Abstract-Atherosclerotic carotid stenosis has been recognized for the past several decades as being responsible for a significant portion of ischemic stroke, particularly the major and disabling ones. This category of stroke distinguished itself as being one of the first ones to have an effective preventive treatment in carotid endarterectomy. It took over 4 decades before major randomized, controlled trials were completed in North America and Europe to provide enough definitive information about its effectiveness, risks, limitations, and categories of patients that most benefit from it. Just like any invasive surgery, endarterectomy is being challenged by minimally invasive stenting, which has already made major technologic leaps and rapid clinical inroads. Stenting has started by tackling patient populations like surgical high-risk patients who were largely avoided in the endarterectomy trials and demonstrated equivalence to it in such populations. The broader applicability of the technique, however, has not been yet adequately investigated. The results so far are greatly reassuring and encouraging to enroll patients in the ongoing randomized trials that will hopefully provide more definitive answers to this issue. Key Words: angioplasty and stenting Ⅲ asymptomatic carotid stenosis Ⅲ carotid endarterectomy Ⅲ carotid stenosis Ⅲ prevention T he first comprehensive description of the relationship between occlusive carotid artery disease and ischemic brain symptoms in 1955 1 by Fisher triggered a momentum in furthering clinical descriptive, experimental, diagnostic, and therapeutic efforts that continue to transform our understanding and management of carotid disease. It took over 40 years for carotid endarterectomy (CEA) to demonstrate its effectiveness and limitations through major randomized trials. Despite these advances and efforts, there remains a lot of uncertainties about many aspects of risks, prognosis, and treatment of carotid stenosis in certain populations and circumstances. Similar to any new technology, the introduction of carotid artery stenting (CAS) as a potential alternative to CEA brought new challenges, questions, and issues. I review the clinical evidence and its limitations including CEA trials and comparisons to published and presented clinical information about CAS. Carotid AtherosclerosisCarotid atherosclerotic disease is a continuum of stages spanning the spectrum from intima-media thickening, to asymptomatic carotid plaque, and to symptomatic carotid disease. Various factors and triggers determine the transformation and evolution from one stage to another. Increasing degrees of atherosclerosis develop in the carotid arteries with older age. The Framingham Heart Study 2 suggests that by the age of 50, less than 1% of the population have carotid stenosis of 50% or greater, but by the age of 75, 9% to 7% of the population will develop a 50% or greater stenosis. Carotid intima-media thickness as measured by ultrasound is rapidly becoming a surrogate marker for systemic atherosclerosis and c...

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Carotid Angioplasty and Stenting versus Carotid Endarterectomy for Treatment of Asymptomatic Carotid Stenosis: A Randomized Trial in a Community Hospital

Abstract: CAS and CEA may be equally effective and safe in treating individuals with asymptomatic carotid stenosis.

Cited by 215 publications

References 54 publications

Randomized Controlled Trials Comparing Endarterectomy and Endovascular Treatment for Carotid Artery Stenosis

Randomized Controlled Trials Comparing Endarterectomy and Endovascular Treatment for Carotid Artery Stenosis

Análise crítica das indicações e resultados do tratamento cirúrgico da doença carotídea

Endarterectomy and Stenting for Asymptomatic Carotid Stenosis

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