Friday, October 15, 2010
carotis hart coronair bloedvaten
Carotid endarterectomy (CEA) is a surgical procedure used to prevent stroke, by correcting stenosis (narrowing) in the common carotid artery. Endarterectomy is the removal of material on the inside (end-) of an artery.
SummaCarotid endarterectomy (CEA) is a surgical procedure used to prevent stroke, by correcting stenosis (narrowing) in the common carotid artery. Endarterectomy is the removal of material on the inside (end-) of an artery.
and Comment
Endarterectomy Is Still Safer Than Stenting in Symptomatic Carotid Stenosis
But stenting might be an acceptable alternative in patients younger than 70.
In several large trials involving patients with symptomatic carotid artery stenosis, endovascular stenting carried greater periprocedural risk than open endarterectomy, but no single trial was large enough to identify subgroups that might be at particular risk with either procedure. To gain statistical power, investigators combined patient-level data from three such trials, yielding a sample of 3454 patients with moderate-to-severe stenosis who were assigned randomly to stenting or endarterectomy.
In an intent-to-treat analysis, significantly more patients assigned to stenting than to endarterectomy reached the primary outcome of any stroke or death within 120 days after randomization (8.9% vs. 5.8%) — a difference that was driven primarily by nondisabling ischemic strokes. Patients younger than 70 had similar outcomes with both treatments, whereas those 70 and older had significantly more primary outcome events with stenting than with endarterectomy (12.0% vs. 5.9%). No significant differences were seen in any other predefined subgroup.
Comment: Unless contraindications to surgery exist, endarterectomy remains the treatment of choice for patients with symptomatic carotid artery stenosis. This study suggests that stenting might be an acceptable alternative in patients younger than 70. But another concern is that recurrent stenosis might be more common after stenting than after endarterectomy — an effect that would be important to these younger patients and that cannot be discerned in these short-term data.
— Bruce Soloway, MD
Published in Journal Watch General Medicine October 14, 2010
Citation(s):
Carotid Stenting Trialists' Collaboration. Short-term outcome after stenting versus endarterectomy for symptomatic carotid stenosis: A preplanned meta-analysis of individual patient data. Lancet 2010 Sep 25; 376:1062. (http://dx.doi.org/10.1016/S0140-6736(10)61009-4)
Medline abstract (Free)
SummaCarotid endarterectomy (CEA) is a surgical procedure used to prevent stroke, by correcting stenosis (narrowing) in the common carotid artery. Endarterectomy is the removal of material on the inside (end-) of an artery.
and Comment
Endarterectomy Is Still Safer Than Stenting in Symptomatic Carotid Stenosis
But stenting might be an acceptable alternative in patients younger than 70.
In several large trials involving patients with symptomatic carotid artery stenosis, endovascular stenting carried greater periprocedural risk than open endarterectomy, but no single trial was large enough to identify subgroups that might be at particular risk with either procedure. To gain statistical power, investigators combined patient-level data from three such trials, yielding a sample of 3454 patients with moderate-to-severe stenosis who were assigned randomly to stenting or endarterectomy.
In an intent-to-treat analysis, significantly more patients assigned to stenting than to endarterectomy reached the primary outcome of any stroke or death within 120 days after randomization (8.9% vs. 5.8%) — a difference that was driven primarily by nondisabling ischemic strokes. Patients younger than 70 had similar outcomes with both treatments, whereas those 70 and older had significantly more primary outcome events with stenting than with endarterectomy (12.0% vs. 5.9%). No significant differences were seen in any other predefined subgroup.
Comment: Unless contraindications to surgery exist, endarterectomy remains the treatment of choice for patients with symptomatic carotid artery stenosis. This study suggests that stenting might be an acceptable alternative in patients younger than 70. But another concern is that recurrent stenosis might be more common after stenting than after endarterectomy — an effect that would be important to these younger patients and that cannot be discerned in these short-term data.
— Bruce Soloway, MD
Published in Journal Watch General Medicine October 14, 2010
Citation(s):
Carotid Stenting Trialists' Collaboration. Short-term outcome after stenting versus endarterectomy for symptomatic carotid stenosis: A preplanned meta-analysis of individual patient data. Lancet 2010 Sep 25; 376:1062. (http://dx.doi.org/10.1016/S0140-6736(10)61009-4)
Medline abstract (Free)
# posted by roodbont @ 5:45 AM 
