Meta‐analysis of the outcomes of treatment of internal carotid artery near occlusion. BJS 2019; 106: 665-671.
Published: 11th April 2019
Authors: A. J. A. Meershoek, E. E. Vries, D. Veen, H. M. Ruijter, G. J. Borst, A. Garcia‐Pastor et al.
Guidelines recommend treating patients with an internal carotid artery near occlusion (ICANO) with best medical therapy (BMT) based on weak evidence. Consequently, patients with ICANO were excluded from randomized trials. The aim of this individual‐patient data (IPD) meta‐analysis was to determine the optimal treatment approach.
A systematic search was performed in MEDLINE, EMBASE and the Cochrane Library databases in January 2018. The primary outcome was the occurrence of any stroke or death within the first 30 days of treatment, analysed by multivariable mixed‐effect logistic regression. The secondary outcome was the occurrence of any stroke or death beyond 30 days up to 1 year after treatment, evaluated by Kaplan–Meier survival analysis.
The search yielded 1526 articles, of which 61 were retrieved for full‐text review. Some 32 studies met the inclusion criteria and pooled IPD were available from 11 studies, including some 703 patients with ICANO. Within 30 days, any stroke or death was reported in six patients (1·8 per cent) in the carotid endarterectomy (CEA) group, five (2·2 per cent) in the carotid artery stenting (CAS) group and seven (4·9 per cent) in the BMT group. This resulted in a higher 30‐day stroke or death rate after BMT than after CEA (odds ratio 5·63, 95 per cent c.i. 1·30 to 24·45; P = 0·021). No differences were found between CEA and CAS. The 1‐year any stroke‐ or death‐free survival rate was 96·1 per cent for CEA, 94·4 per cent for CAS and 81·2 per cent for BMT.
These data suggest that BMT alone is not superior to CEA or CAS with respect to 30‐day or 1‐year stroke or death prevention in patients with ICANO. These patients do not appear to constitute a high‐risk group for surgery, and consideration should made to including them in future RCTs of internal carotid artery interventions.Full text
You may also be interested in
Authors: A. Saratzis, N. E. M. Jaspers, B. Gwilym, O. Thomas, A. Tsui, R. Lefroy et al.
Predicting reamputation risk in patients undergoing lower extremity amputation due to the complications of peripheral artery disease and/or diabetes. BJS 2019; 106: 1026-1034.
Authors: J. M. Czerniecki, M. L. Thompson, A. J. Littman, E. J. Boyko, G. J. Landry, W. G. Henderson et al.
Health gains, costs and cost‐effectiveness of a population‐based screening programme for abdominal aortic aneurysms. BJS 2019; 106: 1043-1054.
Authors: N. Nair, G. Kvizhinadze, G. T. Jones, R. Rush, M. Khashram, J. Roake et al.
Development and validation of a gene expression test to identify hard‐to‐heal chronic venous leg ulcers. BJS 2019; 106: 1035-1042.
Authors: D. C. Bosanquet, A. J. Sanders, F. Ruge, J. Lane, C. A. Morris, W. G. Jiang et al.
Randomized clinical trial
Randomized clinical trial of endovenous laser ablation versus direct and indirect radiofrequency ablation for the treatment of great saphenous varicose veins. BJS 2019; 106: 998-1004.
Authors: S. A. S. Hamann, L. Timmer‐de Mik, W. M. Fritschy, G. R. R. Kuiters, T. E. C. Nijsten, R. R. Bos et al.
Contemporary prevalence of carotid stenosis in patients presenting with ischaemic stroke. BJS 2019; 106: 872-878.
Authors: S. F. Cheng, M. M. Brown, R. J. Simister, T. Richards
Baseline findings of the population‐based, randomized, multifaceted Danish cardiovascular screening trial (DANCAVAS) of men aged 65–74 years. BJS 2019; 106: 862-871.
Authors: J. S. Lindholt, L. M. Rasmussen, R. Søgaard, J. Lambrechtsen, F. H. Steffensen, L. Frost et al.
Randomized clinical trial
Randomized clinical trial of mechanochemical and endovenous thermal ablation of great saphenous varicose veins. BJS 2019; 106: 548-554.
Authors: S. Vähäaho, O. Mahmoud, K. Halmesmäki, A. Albäck, K. Noronen, P. Vikatmaa et al.
Meta‐analysis of long‐term survival after elective endovascular or open repair of abdominal aortic aneurysm. BJS 2019; 106: 523-533.
Authors: R. M. A. Bulder, E. Bastiaannet, J. F. Hamming, J. H. N. Lindeman
Mortality prediction following non‐traumatic amputation of the lower extremity. BJS 2019; 106: 879-888.
Authors: D. C. Norvell, M. L. Thompson, E. J. Boyko, G. Landry, A. J. Littman, W. G. Henderson et al.
Meta‐analysis of clinical trials examining the benefit of structured home exercise in patients with peripheral artery disease. BJS 2019; 106: 319-331.
Authors: J. Golledge, T. P. Singh, C. Alahakoon, J. Pinchbeck, L. Yip, J. V. Moxon et al.
Cost‐effectiveness analysis of a randomized clinical trial of early versus deferred endovenous ablation of superficial venous reflux in patients with venous ulceration. BJS 2019; 106: 555-562.
Authors: D. M. Epstein, M. S. Gohel, F. Heatley, X. Liu, A. Bradbury, R. Bulbulia et al.