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Temporal trends in safety of carotid endarterectomy in asymptomatic patients

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Title: Temporal trends in safety of carotid endarterectomy in asymptomatic patients
Authors: Munster, AB
Franchini, AJ
Qureshi, MI
Thapar, A
Davies, AH
Item Type: Journal Article
Abstract: Objective: To systematically review temporal changes in perioperative safety of carotid endarterectomy (CEA) in asymptomatic individuals in trial and registry studies. Methods: The MEDLINE and EMBASE databases were searched using the terms “carotid” and “endarterectomy” and “asymptomatic” from 1947 to August 23, 2014. Articles dealing with 50%–99% stenosis in asymptomatic individuals were included and low-volume studies were excluded. The primary endpoint was 30-day stroke or death and the secondary endpoint was 30-day all-cause mortality. Statistical analysis was performed using random-effects meta-regression for registry data and for trial data graphical interpretation alone was used. Results: Six trials (n = 4,431 procedures) and 47 community registries (n = 204,622 procedures) reported data between 1983 and 2013. Registry data showed a significant decrease in postoperative stroke or death incidence over the period 1991–2010, equivalent to a 6% average proportional annual reduction (95% credible interval [CrI] 4%–7%; p < 0.001). Considering postoperative all-cause mortality, registry data showed a significant 5% average proportional annual reduction (95% CrI 3%–9%; p < 0.001). Trial data showed a similar visual trend. Conclusions: CEA is safer than ever before and high-volume registry results closely mirror the results of trials. New benchmarks for CEA are a stroke or death risk of 1.2% and a mortality risk of 0.4%. This information will prove useful for quality improvement programs, for health care funders, and for those re-examining the long-term benefits of asymptomatic revascularization in future trials.
Issue Date: 28-Jul-2015
Date of Acceptance: 22-Jan-2015
URI: http://hdl.handle.net/10044/1/43226
DOI: https://dx.doi.org/10.1212/WNL.0000000000001781
ISSN: 0028-3878
Publisher: Medknow Publications
Start Page: 365
End Page: 372
Journal / Book Title: Neurology
Volume: 85
Issue: 4
Copyright Statement: © 2015 American Academy of Neurology
Sponsor/Funder: The Circulation Foundation
Rosetrees Trust
Funder's Grant Number: N/A
A573
Keywords: Science & Technology
Life Sciences & Biomedicine
Clinical Neurology
Neurosciences & Neurology
QUALITY IMPROVEMENT PROGRAM
VASCULAR-SURGERY GUIDELINES
RANDOMIZED CONTROLLED-TRIAL
ARTERY STENOSIS
MYOCARDIAL-INFARCTION
RISK STRATIFICATION
CLINICAL-TRIAL
OUTCOMES
STROKE
DEATH
Cause of Death
Databases, Factual
Endarterectomy, Carotid
Humans
Incidence
Patient Safety
Postoperative Complications
Registries
Stroke
Neurology & Neurosurgery
1103 Clinical Sciences
1109 Neurosciences
1702 Cognitive Science
Publication Status: Published
Appears in Collections:Division of Surgery
Faculty of Medicine



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