In Patients with a Stroke Attributable to a Carotid Artery Stenosis, Does Waiting to Operate Reduce the Risk of Complications?
| Autor: | David A. Nation, Benjamin M. Jackson |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
business.industry medicine.medical_treatment Carotid endarterectomy medicine.disease law.invention Stenosis Randomized controlled trial law Internal medicine medicine Cardiology cardiovascular diseases Embolization Carotid stenting business Stroke Endarterectomy Cause of death |
| Zdroj: | Difficult Decisions in Surgery: An Evidence-Based Approach ISBN: 9783319332918 |
| DOI: | 10.1007/978-3-319-33293-2_29 |
| Popis: | Stroke is a significant cause of death and morbidity in the United States, with many patients affected by stroke originating from embolization of carotid artery plaque. Large multicenter randomized controlled trials have demonstrated the efficacy of carotid endarterectomy (CEA) and carotid stenting at minimizing stroke risk in select patient populations. The optimal timing of intervention should optimize stroke prevention while minimizing the risk of complications. Pooled data from the large randomized controlled trials demonstrated that endarterectomy is best performed within 2 weeks of symptom onset, after which time the benefit of carotid endarterectomy for stroke prevention declines. Data is mixed regarding the risk/benefit profile of very early endarterectomy performed within the first 48 h. For patients with stroke in evolution or crescendo transient ischemic attacks, urgent carotid endarterectomy may be of benefit in highly selected patients but the data do not clearly support either urgent intervention or medical management. |
| Databáze: | OpenAIRE |
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