The Experts below are selected from a list of 279 Experts worldwide ranked by ideXlab platform
Henry J M Barnett - One of the best experts on this subject based on the ideXlab platform.
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benefit of Carotid Endarterectomy in patients with symptomatic moderate or severe stenosis north american symptomatic Carotid Endarterectomy trial collaborators
The New England Journal of Medicine, 1998Co-Authors: Henry J M Barnett, D W Taylor, Michael Eliasziw, Allan J Fox, Gary G Ferguson, R B Haynes, R N Rankin, G P Clagett, Vladimir Hachinski, David L SackettAbstract:Background Previous studies have shown that Carotid Endarterectomy in patients with symptomatic severe Carotid stenosis (defined as stenosis of 70 to 99 percent of the luminal diameter) is beneficial up to two years after the procedure. In this clinical trial, we assessed the benefit of Carotid Endarterectomy in patients with symptomatic moderate stenosis, defined as stenosis of less than 70 percent. We also studied the durability of the benefit of Endarterectomy in patients with severe stenosis over eight years of follow-up. Methods Patients who had moderate Carotid stenosis and transient ischemic attacks or nondisabling strokes on the same side as the stenosis (ipsilateral) within 180 days before study entry were stratified according to the degree of stenosis (50 to 69 percent or <50 percent) and randomly assigned either to undergo Carotid Endarterectomy (1108 patients) or to receive medical care alone (1118 patients). The average follow-up was five years, and complete data on outcome events were availa...
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Status of Carotid Endarterectomy.
Current opinion in neurology, 1994Co-Authors: Henry J M Barnett, Heather MeldrumAbstract:The randomized clinical trial has been brought to bear on the indications and the search for benefit for the surgical procedure of Carotid Endarterectomy. Progress has been made and some answers are available. It is not too optimistic to state that in a few years time, we will be able to state with some degree of finality, which patients with symptomatic disease will benefit from Carotid Endarterectomy, which ones will be better treated with medical therapy alone, and whether or not there is a group of patients, despite being asymptomatic, who should be advised to have this procedure.
Lippincott Williams Wilkins - One of the best experts on this subject based on the ideXlab platform.
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north american symptomatic Carotid Endarterectomy trial methods patient characteristics and progress
Stroke, 1991Co-Authors: Lippincott Williams WilkinsAbstract:Fifty North American centers have combined to evaluate the benefit of Carotid Endarterectomy in randomized patients who have experienced symptoms related to arteriosclerotic stenosis of the Carotid artery and who have received either best medical therapy alone or best medical therapy plus Carotid Endarterectomy. The outcome events are nonfatal and fatal stroke or death. A three-tier system identifies and adjudicates the type, severity, and location of each stroke and the cause of any death. Data about patients submitted to Carotid Endarterectomy outside the trial are compiled at the Nonrandomized Data Center at the Mayo Clinic. Between December 27, 1987, and October 1, 1990, 1,212 patients were randomized, 596 to medical therapy, 616 to Carotid Endarterectomy. Cross-over from the medical to the surgical arm has been low (4.2%). Patients eligible for the trial, but not randomized totaled 1,044; their characteristics were similar to those randomized so that, for the type of symptomatic patient in this study, our conclusions about the benefit of Carotid Endarterectomy can be generalized. Patients excluded by medical criteria totaled 679. Another 1,591 had Carotid Endarterectomy, but either lacked the disease under study, were asymptomatic, or received inadequate investigation to meet entry criteria. We set sample size at 1,900 patients, with continuing enrollment. The Monitoring Committee reviews at intervals the confidential analyses performed on the groups with moderate (30-69%) and severe (70-99%) stenosis. Stopping rules will be invoked for one or both groups if unequivocal benefit or harm is identified.
David L Sackett - One of the best experts on this subject based on the ideXlab platform.
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benefit of Carotid Endarterectomy in patients with symptomatic moderate or severe stenosis north american symptomatic Carotid Endarterectomy trial collaborators
The New England Journal of Medicine, 1998Co-Authors: Henry J M Barnett, D W Taylor, Michael Eliasziw, Allan J Fox, Gary G Ferguson, R B Haynes, R N Rankin, G P Clagett, Vladimir Hachinski, David L SackettAbstract:Background Previous studies have shown that Carotid Endarterectomy in patients with symptomatic severe Carotid stenosis (defined as stenosis of 70 to 99 percent of the luminal diameter) is beneficial up to two years after the procedure. In this clinical trial, we assessed the benefit of Carotid Endarterectomy in patients with symptomatic moderate stenosis, defined as stenosis of less than 70 percent. We also studied the durability of the benefit of Endarterectomy in patients with severe stenosis over eight years of follow-up. Methods Patients who had moderate Carotid stenosis and transient ischemic attacks or nondisabling strokes on the same side as the stenosis (ipsilateral) within 180 days before study entry were stratified according to the degree of stenosis (50 to 69 percent or <50 percent) and randomly assigned either to undergo Carotid Endarterectomy (1108 patients) or to receive medical care alone (1118 patients). The average follow-up was five years, and complete data on outcome events were availa...
Michael Belkin - One of the best experts on this subject based on the ideXlab platform.
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Carotid Endarterectomy: Who is the high-Risk patient?
Seminars in vascular surgery, 2004Co-Authors: Louis L. Nguyen, Michael S. Conte, Amy B. Reed, Michael BelkinAbstract:The role of Carotid Endarterectomy in the prevention of stroke was validated by two randomized clinical trials, the North American Symptomatic Carotid Endarterectomy (NASCET) and the Asymptomatic Carotid Atherosclerosis Study (ACAS). However, these trials excluded patients at high risk for perioperative stroke and other morbidity, raising concerns for the applicability of the trial results to the general population. Some have also suggested these "high-risk" patients are better suited for Carotid artery stenting with the belief that stenting has lower morbidity and mortality. In this article, we review many of the commonly accepted high-risk factors for Carotid Endarterectomy (CEA) and examine their outcomes. High-risk patients are more common than generally believed and their outcomes may be the same with Carotid Endarterectomy as it is with Carotid stenting. Truly "high-risk" patients with shortened life expectancy are best served with no intervention.
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Contralateral intracerebral hemorrhage after Carotid Endarterectomy
Journal of vascular surgery, 1995Co-Authors: Husam H. Balkhy, Michael BelkinAbstract:Abstract Postoperative intracerebral hemorrhage is a rare but devastating complication of Carotid Endarterectomy. Intracerebral hemorrhage on the side contralateral to the Carotid Endarterectomy has been reported only twice before in the literature. We present a case of fatal postoperative right intracerebral hemorrhage after left Carotid Endarterectomy in an 81-year-old patient. A review of the literature and a discussion of the pathophysiology of this condition is presented. (J Vasc Surg 1995;22:68-72.)
Steven G. Katz - One of the best experts on this subject based on the ideXlab platform.
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Are Octogenarians at High Risk for Carotid Endarterectomy
Journal of the American College of Surgeons, 2008Co-Authors: Amy K. Bremner, Steven G. KatzAbstract:Background Several prospective randomized trials have proved Carotid Endarterectomy to be safe and effective for both symptomatic and asymptomatic patients younger than 80 years of age. Recently, Carotid artery stenting (CAS) has been approved for use in selected high-risk patients. It has been proposed that being an octogenarian places patients in this high-risk category. Study Design All patients between the ages of 80 to 89 years undergoing Carotid Endarterectomy during a 12-year period were included in the study. Information included indications for Carotid Endarterectomy, associated risk factors, length of stay, and hospital course. Perioperative morbidity and mortality, including neurologic events and myocardial infarction, were recorded. Results A total of 103 Carotid endarterectomies were performed in 95 octogenarians. Procedures were performed on 59 men and 36 women. Indications for operation included symptomatic Carotid stenosis in 44 patients (43%) and asymptomatic Carotid stenosis in 59 (57%). Associated risk factors included diabetes mellitus (17%), hypertension (76%), coronary artery disease (28%), hyperlipidemia (39%), and history of smoking (42%). There were 4 perioperative neurologic complications, which included 1 transient ischemic attack (0.97%), 2 minor strokes (1.94%), and 1 major stroke (0.97%). There were no deaths. Conclusions Combined end points for adverse events are acceptable in the octogenarian. Carotid Endarterectomy remains the gold standard for treatment of extracranial Carotid disease in all age groups. Age alone should not place patients in the high-risk category for Carotid Endarterectomy.