scholarly journals Long-term Outcomes of Stenting and Endarterectomy for Symptomatic Carotid Stenosis: A Preplanned Pooled Analysis of Individual Patient Data

2019 ◽  
Vol 70 (1) ◽  
pp. 328
Author(s):  
T.G. Brott ◽  
D. Calvet ◽  
G. Howard ◽  
J. Gregson ◽  
A. Algra ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Individual Patient Data ◽  
Pooled Analysis ◽  
Patient Data ◽  
Long Term Outcomes ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis

scholarly journals A pooled analysis of individual patient data from trials of endarterectomy for symptomatic carotid stenosis: efficacy of surgery in important subgroups

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 328-328
Author(s):  
Peter M Rothwell Dr ◽  
Sergei A Gutnikov Dr ◽  
Marc R Mayberg Professor ◽  
Charles P Warlow Professor ◽  
Henry Jm Barnett Professor
Keyword(s):  
Ischaemic Stroke ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Individual Patient Data ◽  
Patient Data ◽  
Surface Irregularity ◽  
Significant Heterogeneity ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis ◽  
Near Occlusion

65 Benefit from carotid endarterectomy (CEA) depends on the degree of symptomatic stenosis, but is also likely to be influenced by other clinical and angiographic characteristics. However, individual trials have been too small to allow reliable subgroup analysis. We therefore studied pooled individual patient data from the European Carotid Surgery Trial, the North American Symptomatic Carotid Endarterectomy Trial and the Veterans Administration trial #309. We determined the effect of CEA in 11 predefined subgroups: age (<65, 65–74, 75+), sex, type of presenting event (cerebral vs ocular; TIA vs stroke; lacunar vs non-lacunar), side of presenting event, months since last event (<1, 2–3, 4+), diabetes, plaque surface irregularity, near-occlusion, and contralateral carotid occlusion. There were statistically significant interactions between the risk of ipsilateral ischaemic stroke in the medical group and 8 of the 11 subgroup variables. In the surgery group, there were interactions between the operative risk of stroke and death and 6 subgroup variables. We therefore assessed heterogeneity of overall treatment effect (any ipsilateral ischaemic stroke and surgical stroke/death) in these subgroups. There was clinically and statistically significant heterogeneity within 5 subgroups: benefit from surgery increased with age, was greater in men than women; decreased with time since presenting event; was greater after stroke than TIA, and was absent in cases of near-occlusion. For example, in patients with 50–69% stenosis, the 5 yr absolute risk reduction was 10% (95% CI = 3–10, P=0.0005) in men and -3% (95% CI = -8 - 2, P=0.8) in women (overall interaction, P=0.003). There were also important differences in the effect of surgery for lacunar and non-lacunar stroke. Patients who are most likely to benefit from CEA cannot be identified using the degree of symptomatic carotid stenosis alone. Several other clinical and angiographic characteristics influence the efficacy of surgery. Optimal selection of patients will require a risk-modelling approach using multiple baseline characteristics.

Abstract P566: Identifying Sex-Specific Differences in the Carotid Revascularization Literature: Findings From a Scoping Review

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Vignan Yogendrakumar ◽  
Michel C Shamy ◽  
Brian Dewar ◽  
Dean Fergusson ◽  
Dar Dowlatshahi ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Medical Therapy ◽  
Scoping Review ◽  
Sufficient Information ◽  
Significant Heterogeneity ◽  
Long Term Outcomes ◽  
Carotid Revascularization ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis

Background and Purpose: No systematic review of the literature has dedicated itself to looking at the management of symptomatic carotid stenosis in women. In this scoping review, we aimed to identify all randomized controlled trials (RCTs) that reported sex-specific outcomes for patients who underwent carotid revascularization, and determine whether sufficient information is reported within these studies to assess women’s short and long-term outcomes. Methods: We systematically searched Medline, Embase, Pubmed, and Cochrane libraries for RCTs published between 1991 and 2020 that included women and compared either endarterectomy with stenting, or any revascularization (endarterectomy or stenting) with medical therapy in patients with symptomatic high grade (greater than 50%) carotid stenosis. Results: From 1,537 references examined, 27 eligible studies were identified. Sex-specific outcomes were reported in 13 studies. Baseline patient characteristics of enrolled women were reported in 2 of those 13 studies. Common outcomes reported included stroke and death, however there was significant heterogeneity in the reporting of both periprocedural and long-term outcomes. Sex-specific differences relating to the degree of stenosis and time from index event to treatment were limited to studies comparing endarterectomy to medical therapy. Adverse events were not reported by sex. Conclusions: Half of the previously published RCTs and systematic reviews report sex-specific outcomes. Detailed analysis on the benefits of carotid artery intervention for women with symptomatic stenosis is limited . Further analysis with individual patient data and a network meta-analysis is the necessary next step to better assess the treatment effects of carotid management in women.

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