期刊
JOURNAL OF STROKE & CEREBROVASCULAR DISEASES
卷 26, 期 12, 页码 2888-2892出版社
ELSEVIER
DOI: 10.1016/j.jstrokecerebrovasdis.2017.07.011
关键词
Outcomes; visual aid tool; endarterectomy; stroke; carotid; angioplasty; stenting; decision making
资金
- Heart and Stroke Foundation of Canada
- Edward and Alma Saraydar Neurosciences Fund
- Opportunities Fund of the Academic Health Sciences Centre Alternative Funding Plan of the Academic Medical Organization of Southwestern Ontario
Background: Because of the large amount of information to process and the limited time of a clinical consult, choosing between carotid endarterectomy (CEA) and carotid angioplasty with stenting (CAS) can be confusing for patients with severe symptomatic internal carotid stenosis (ICA). Goal: We aim to develop a visual aid tool to help clinicians and patients in the decision-making process of selecting between CEA and CAS. Materials and Methods: Based on pooled analysis from randomized controlled trials including patients with symptomatic and severe ICA (SSICA), we generated visual plots comparing CEA with CAS for 3 prespecified postprocedural time points: (1) any stroke or death at 4 months, and (2) any stroke or death in the first 30 days and ipsilateral stroke thereafter at 5 years and (3) at 10 years. Results: A total of 4574 participants (2393 assigned to CAS, and 2361 to CEA) were included in the analyses. For every 100 patients with SSICA, 6 would develop any stroke or death in the CEA group compared with 9 undergoing CAS at 4 months (hazard ratio [HR] 1.53; 95% CI 1.20-1.95). At 5 years, 7 patients in the CEA group would develop any periprocedural stroke or death and ipsilateral stroke thereafter versus 12 undergoing CAS (HR 1.72; 95% CI 1.24-2.39), compared with 10 patients in the CEA and 13 in the CAS groups at 10 years (HR 1.17; 95% CI 0.82-1.66). Conclusion: Visual aids presented in this study could potentially help patients with severe symptomatic internal carotid stenosis to better weigh the risks and benefits of CEA versus CAS as a function of time, allowing for the prioritization of personal preferences, and should be prospectively assessed.
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