Carotid endarterectomy--an evidence-based review: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology
| Autor: | Oscar R. Benavente, David C. Hess, Askiel Bruno, Thomas E. Feasby, Robert G. Holloway, J. D. Spence, Jeffrey L. Saver, Robert Côté, Stanley N. Cohen, Seemant Chaturvedi, Janet Wilterdink, B. Stern |
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| Rok vydání: | 2005 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Carotid endarterectomy Asymptomatic Risk Assessment law.invention Postoperative Complications Randomized controlled trial law medicine Humans Carotid Stenosis Mortality Endarterectomy Clinical Trials as Topic Endarterectomy Carotid Evidence-Based Medicine Aspirin Dose-Response Relationship Drug business.industry Patient Selection Absolute risk reduction Perioperative medicine.disease Cardiac surgery Surgery Causality Stroke Ophthalmology Stenosis Treatment Outcome Female Neurology (clinical) medicine.symptom business Platelet Aggregation Inhibitors |
| Zdroj: | Department of Medicine Publications |
| ISSN: | 1526-632X |
| Popis: | Objective: To assess the efficacy of carotid endarterectomy for stroke prevention in asymptomatic and symptomatic patients with internal carotid artery stenosis. Additional clinical scenarios, such as use of endarterectomy combined with cardiac surgery, are also reviewed. Methods: The authors selected nine important clinical questions. A systematic search was performed for articles from 1990 (the year of the last statement) until 2001. Additional articles from 2002 through 2004 were included using prespecified criteria. Two reviewers also screened for other relevant articles from 2002 to 2004. Case reports, review articles, technical studies, and single surgeon case series were excluded. Results: For several questions, high quality randomized clinical trials had been completed. Carotid endarterectomy reduces the stroke risk compared to medical therapy alone for patients with 70 to 99% symptomatic stenosis (16% absolute risk reduction at 5 years). There is a smaller benefit for patients with 50 to 69% symptomatic stenosis (absolute risk reduction 4.6% at 5 years). There is a small benefit for asymptomatic patients with 60 to 99% stenosis if the perioperative complication rate is low. Aspirin in a dose of 81 to 325 mg per day is preferred vs higher doses (650 to 1,300 mg per day) in patients undergoing endarterectomy. Conclusions: Evidence supports carotid endarterectomy for severe (70 to 99%) symptomatic stenosis (Level A). Endarterectomy is moderately useful for symptomatic patients with 50 to 69% stenosis (Level B) and not indicated for symptomatic patients with |
| Databáze: | OpenAIRE |
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