| [PMID]: | 28455318 |
| [Au] Autor: | Rantner B; Kollerits B; Roubin GS; Ringleb PA; Jansen O; Howard G; Hendrikse J; Halliday A; Gregson J; Eckstein HH; Calvet D; Bulbulia R; Bonati LH; Becquemin JP; Algra A; Brown MM; Mas JL; Brott TG; Fraedrich G; Carotid Stenosis Trialists' Collaboration |
| [Ad] Endereço: | From the Department of Vascular Surgery (B.R., G.F.) and Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology (B.K.), Medical University of Innsbruck, Austria; Cardiovascular Associates of the Southeast, Birmingham, AL (G.S.R.); Department of Neurolog |
| [Ti] Título: | Early Endarterectomy Carries a Lower Procedural Risk Than Early Stenting in Patients With Symptomatic Stenosis of the Internal Carotid Artery: Results From 4 Randomized Controlled Trials. |
| [So] Source: | Stroke;48(6):1580-1587, 2017 06. |
| [Is] ISSN: | 1524-4628 |
| [Cp] País de publicação: | United States |
| [La] Idioma: | eng |
| [Ab] Resumo: | BACKGROUND AND PURPOSE: Patients undergoing carotid endarterectomy (CEA) for symptomatic stenosis of the internal carotid artery benefit from early intervention. Heterogeneous data are available on the influence of timing of carotid artery stenting (CAS) on procedural risk. METHODS: We investigated the association between timing of treatment (0-7 days and >7 days after the qualifying neurological event) and the 30-day risk of stroke or death after CAS or CEA in a pooled analysis of individual patient data from 4 randomized trials by the Carotid Stenosis Trialists' Collaboration. Analyses were done per protocol. To obtain combined estimates, logistic mixed models were applied. RESULTS: Among a total of 4138 patients, a minority received their allocated treatment within 7 days after symptom onset (14% CAS versus 11% CEA). Among patients treated within 1 week of symptoms, those treated by CAS had a higher risk of stroke or death compared with those treated with CEA: 8.3% versus 1.3%, risk ratio, 6.7; 95% confidence interval, 2.1 to 21.9 (adjusted for age at treatment, sex, and type of qualifying event). For interventions after 1 week, CAS was also more hazardous than CEA: 7.1% versus 3.6%, adjusted risk ratio, 2.0; 95% confidence interval, 1.5 to 2.7 ( value for interaction with time interval 0.06). CONCLUSIONS: In randomized trials comparing stenting with CEA for symptomatic carotid artery stenosis, CAS was associated with a substantially higher periprocedural risk during the first 7 days after the onset of symptoms. Early surgery is safer than stenting for preventing future stroke. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00190398; URL: http://www.controlled-trials.com. Unique identifier: ISRCTN57874028; Unique identifier: ISRCTN25337470; URL: http://www.clinicaltrials.gov. Unique identifier: NCT00004732. |
| [Mh] Termos MeSH primário: |
Artéria Carótida Interna/cirurgia
Estenose das Carótidas/cirurgia
Endarterectomia das Carótidas/efeitos adversos
Procedimentos Endovasculares/efeitos adversos
Avaliação de Processos e Resultados (Cuidados de Saúde)/estatística & dados numéricos
Stents/efeitos adversos
Acidente Vascular Cerebral/etiologia
|
| [Mh] Termos MeSH secundário: |
Idoso
Estenose das Carótidas/epidemiologia
Endarterectomia das Carótidas/estatística & dados numéricos
Procedimentos Endovasculares/estatística & dados numéricos
Feminino
Seres Humanos
Masculino
Meia-Idade
Stents/estatística & dados numéricos
Acidente Vascular Cerebral/epidemiologia
Fatores de Tempo
|
| [Pt] Tipo de publicação: | JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T |
| [Em] Mês de entrada: | 1707 |
| [Cu] Atualização por classe: | 180305 |
[Lr] Data última revisão:
| 180305 |
| [Sb] Subgrupo de revista: | IM |
| [Da] Data de entrada para processamento: | 170430 |
| [Cl] Clinical Trial: | ClinicalTrial
|
| [St] Status: | MEDLINE |
| [do] DOI: | 10.1161/STROKEAHA.116.016233 |
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