Objectives: This single-center, randomized, clinical trial was designed to determine the 10-year comparative efficacy and durability of carotid angioplasty and stenting (CAS) versus carotid endarterectomy (CEA) in preventing ipsilateral ischemic stroke in symptomatic and asymptomatic patients with high-grade carotid artery stenosis.
The answer to the question “What is the optimal management of patients with carotid artery disease?” remains hotly debated and contentious. In the 1990s, the elements of this debate were focused on the relative merits of carotid endarterectomy (CEA) versus medical therapy (basically, aspirin), which most physicians considered settled by 4 randomized clinical trials in patients with symptomatic (1,) and asymptomatic (3,) carotid stenosis. Taken together, these trials formed the base of evidence that supported the recommendations for CEA in symptomatic carotid stenosis >50% and in asymptomatic carotid stenosis >70%. In the last 15 years, the findings of these studies have been challenged on the basis of 2 important therapeutic innovations: one in pharmacological approaches to coronary, peripheral, and cerebrovascular atherosclerosis, and the other in the development of minimally invasive techniques for carotid revascularization relying on carotid artery stenting (CAS) and embolic protection devices (EPDs). From a clinical trials perspective alone, more than $100 million have been devoted to studies of the technique of carotid revascularization, whereas there are no large-scale clinical trials of optimal medical therapy for stroke prevention in patients with severe carotid stenosis.
Objectives: This study sought to characterize usage and outcomes of carotid stenting platforms.
Comparative effectiveness research (CER) is a theme that will play an increasingly important role in the discourse of medical care. The Institute of Medicine defines CER as “the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care” (1). Most commonly, CER is used in the context of the politically-charged environment surrounding the Affordable Care Act, in which the explicitly stated purpose of CER is to rein in the growth of healthcare costs, largely by demanding evidence that newer, more expensive modalities be demonstrated to be more clinically effective and cost-effective than less expensive modalities as a condition for reimbursement 2. Whereas these are the principal domains for policy-makers and payers, clinical providers are also concerned with a somewhat more parochial issue: Given that we confront a clinical issue with a particular approach (e.g., a procedure such as carotid artery stenting [CAS]), which of several available alternative tools is the best for conducting the procedure?
Objectives: The purpose of this study was to evaluate and compare outcomes of patients undergoing carotid artery stenting (CAS) for ipsilateral restenosis, after either previous CAS or carotid artery endarterectomy (CEA) (CAS-R group), with those of patients who had CAS performed for de novo carotid atherosclerotic stenosis (CAS-DN group).
Background and Purpose: Embolic protection devices (EPD) may provide a mechanism to reduce peri-procedural strokes. They are advocated by consensus guidelines and mandated for Medicare reimbursement. However, outcomes data remain mixed. We aimed to characterize the population of patients undergoing unprotected carotid artery stenting (CAS) and assess the utility of distal filter EPD (F-EPD) in elective CAS.
Background: Arterial ischaemic stroke is an important cause of acquired brain injury in children. Few prospective population-based studies of childhood arterial ischaemic stroke have been undertaken. We aimed to investigate the epidemiology and clinical features of childhood arterial ischaemic stroke in a population-based cohort.
Background: The decision of whether to treat incidental intracranial saccular aneurysms is complicated by limitations in current knowledge of their natural history. We combined individual patient data from prospective cohort studies to determine predictors of aneurysm rupture and to construct a risk prediction chart to estimate 5-year aneurysm rupture risk by risk factor status.
Background: Use of alteplase improves outcome in some patients with stroke. Several types of barrier frequently prevent its use. We assessed whether a standardised, barrier-assessment, multicomponent intervention could increase alteplase use in community hospitals in Michigan, USA.
Background: Transient isolated brainstem symptoms (eg, isolated vertigo, dysarthria, diplopia) are not consistently classified as transient ischaemic attacks (TIAs) and data for prognosis are limited. If some of these transient neurological attacks (TNAs) are due to vertebrobasilar ischaemia, then they should be common during the days and weeks preceding posterior circulation strokes. We aimed to assess the frequency of TNAs before vertebrobasilar ischaemic stroke.
Objective: To determine the impact of contralateral carotid occlusion (CCO) and/or vertebral artery occlusion (VAO) on the development of early postoperative neurologic complications after carotid endarterectomy (CEA) or carotid artery stenting (CAS).
Objective: While patient eligibility for carotid artery stenting (CAS) is well established, the intraoperative technique remains widely varied. The decision to perform poststent ballooning (PSB) is operator-dependent and often influenced by the interpretation of poststent angiography. While visually creating a greater luminal diameter, it is unclear whether PSB has immediate risks or long-term benefits. The purpose of this report is to determine whether PSB has any effects on periprocedural hemodynamic stability.
Purpose: To assess the safety and efficacy of carotid artery stenting (CAS) of the left internal carotid artery (LICA) from a right radial/brachial approach in patients with bovine aortic arch.
Background and Purpose: Currently, several new stent retriever devices for acute stroke treatment are under development and early clinical evaluation. Preclinical testing under standardized conditions is an important first step to evaluate the technical performance and potential of these devices. The aim of this study was to evaluate the immediate recanalization effect, recanalization efficacy, thrombus-device interaction, and safety of a new stent retriever intended for thrombectomy in patients with acute stroke.
Background and Purpose: Recanalization may not result in better clinical outcomes after ischemic stroke. We determined the incidence and significant predictors of CMR, defined as CT angiographic recanalization and a good clinical outcome, after IV-rtPA in acute ischemic stroke. A CMR score was devised and tested.
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