umu.sePublications
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Meta-analysis of the outcomes of treatment of internal carotid arterynear occlusion
Show others and affiliations
2019 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 106, no 6, p. 665-671Article in journal (Refereed) Published
Abstract [en]

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019. Vol. 106, no 6, p. 665-671
National Category
Neurology
Identifiers
URN: urn:nbn:se:umu:diva-169145DOI: 10.1002/bjs.11159PubMedID: 30973990OAI: oai:DiVA.org:umu-169145DiVA, id: diva2:1416216
Available from: 2020-03-23 Created: 2020-03-23 Last updated: 2020-03-23Bibliographically approved

Open Access in DiVA

fulltext(587 kB)10 downloads
File information
File name FULLTEXT03.pdfFile size 587 kBChecksum SHA-512
7ebf2fd5006963357a392aaa6e58d7ca2dd30c8f059fe8f9b771f10b2baaf0c4ef96c59649df29044ac9b2998a3ab8db911d95d6f91ddead2af1e62ff2383cdc
Type fulltextMimetype application/pdf

Other links

Publisher's full textPubMed

Authority records BETA

Johansson, Elias

Search in DiVA

By author/editor
Johansson, Elias
By organisation
Wallenberg Centre for Molecular Medicine at Umeå University (WCMM)
In the same journal
British Journal of Surgery
Neurology

Search outside of DiVA

GoogleGoogle Scholar
Total: 10 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 12 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf