Carotid Endarterectomy versus Carotid Stenting or Best Medical Treatment in Asymptomatic Patients with Significant Carotid Stenosis: A meta-analysis

Galyfos, George; Sahsamanis, Georgios; Anastasiadou, Christiana; Sachmpazidis, Ioannis; Kikiras, Konstantinos; Kastrisios, Georgios; Giannakakis, Sotirios; Papapetrou, Anastasios; Papacharalampous, Gerasimos; Maltezos, Chrisostomos

doi:10.1016/j.carrev.2018.07.003

Cited by 23 publications

(22 citation statements)

References 31 publications

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“…The majority of RCTs investigating CEA versus CAS found significant differences in perioperative outcomes, largely in symptomatic patients [17]. In our study, 48.1% (26/54) of CAD websites distinguished between symptomatic and asymptomatic CAD.…”

Section: Renderxmentioning

confidence: 52%

Carotid Endarterectomy Versus Carotid Artery Stenting: Survey of the Quality, Readability, and Treatment Preference of Carotid Artery Disease Websites

Strauss¹,

Yacob²,

Bhandari³

et al. 2020

Interact J Med Res

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Background The internet is becoming increasingly more important in the new era of patient self-education. Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are recognized interventions to treat patients with carotid artery stenosis. Using the Google search platform, patients encounter many websites with conflicting information, which are sometimes difficult to understand. This lack of accessibility creates uncertainty or bias toward interventions for carotid artery disease. The quality, readability, and treatment preference of carotid artery disease (CAD) websites have not yet been evaluated. Objective This study aimed to explore the quality, readability, and treatment preference of CAD websites. Methods We searched Google Canada for 10 CAD-related keywords. Returned links were assessed for publication date, medical specialty and industry affiliation, presence of randomized controlled trial data, differentiation by symptomatic status, and favored treatment. Website quality and readability were rated by the DISCERN instrument and Gunning Fog Index. Results We identified 54 unique sites: 18 (33.3%) by medical societies or individual physicians, 11 (20.4%) by government organizations, 9 (16.7%) by laypersons, and 1 (1.9%) that was industry-sponsored. Of these sites, 26 (48.1%) distinguished symptomatic from asymptomatic CAD. A majority of sites overall (57.4%) and vascular-affiliated (72.7%) favored CEA. In contrast, radiology- and cardiology-affiliated sites demonstrated the highest proportion of sites favoring CAS, though they were equally likely to favor CEA. A large proportion (21/54, 38.9%) of sites received poor quality ratings (total DISCERN score <48), and the majority (41/54, 75.9%) required a reading level greater than a high school senior. Conclusions CAD websites are often produced by government organizations, medical societies, or physicians, especially vascular surgeons. Sites ranged in quality, readability, and differentiation by symptomatic status. Google searches of CAD-related terms are more likely to yield sites favoring CEA. Future research should determine the extent of website influence on CAD patients’ treatment decisions.

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Section: Renderxmentioning

confidence: 52%

Carotid Endarterectomy Versus Carotid Artery Stenting: Survey of the Quality, Readability, and Treatment Preference of Carotid Artery Disease Websites

Strauss¹,

Yacob²,

Bhandari³

et al. 2020

Interact J Med Res

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“…28 Furthermore, interim results of the Stent-Protected Angioplasty versus Carotid Endarterectomy-2 (SPACE-2) study provided new evidence of the non-inferiority of contemporary BMT in treating patients with ACAS. 30 Although comprehensive comparisons were reported by the previous meta-analyses of Galyfos et al 31 and Barkat et al, 32 they did not clarify the impact of lipidlowering drugs on current BMT when compared with carotid interventions.…”

Section: Introductionmentioning

confidence: 93%

Treatment strategies for asymptomatic carotid artery stenosis in the era of lipid-lowering drugs: protocol for a systematic review and network meta-analysis

Bai

Feng

et al. 2020

BMJ Open

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IntroductionCarotid endarterectomy (CEA), carotid artery stenting (CAS) and best medical therapy (BMT) are the major treatments used for significant asymptomatic carotid artery stenosis (ACAS, ≥50%). However, the widespread use of lipid-lowering drugs in this century has improved BMT outcomes. This study aims to compare the treatment efficacy of current BMT, CEA+BMT and CAS+BMT in patients with significant ACAS.Methods and analysisThis protocol was designed based on the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Publication time for studies will be set from 1 January 2000 to 1 June 2020. We will search three databases: PubMed, EMBASE and The Cochrane Library. Suitable randomised controlled studies will be screened. The primary outcomes will include short-term and long-term mortality, stroke and myocardial infarction. OR and HR for dichotomous data and time-to-event data with 95% CIs will be calculated. Treatment effects among different therapies will be ranked according to the surface under the cumulative ranking curve and mean rank. A comprehensive evaluation of the risk of bias, heterogeneity and transitivity will be performed before data synthesis. Consistency and evidence quality will also be assessed.Ethics and disseminationThere will be no need for ethics approval as this systematic review is a summary and analysis of existing literature. Final results may be presented in international conferences or a peer-reviewed journal.PROSPERO registration numberCRD42019138942.

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“…Patienten mit einer asymptomatischen Karotisstenose haben ein sehr geringes Schlaganfallrisiko von weniger als 0,5 % pro Jahr bei einer guten medizinischen Behandlung [31,32]. Die ursprünglichen randomisierten Studien, bei denen die Karotisendarteriektomie mit einer optimierten medizinischen Behandlung verglichen wurde, wurden zu einer Zeit durchgeführt, zu der keine optimale medizinische Therapie einschließlich Statine zur Verfügung stand [33].…”

Section: Asymptomatische Karotisstenoseunclassified

Primärprävention des Schlaganfalls

Diener¹,

Gerloff²

2020

Nervenheilkunde

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ZUSAMMENFASSUNGDer Schlaganfall ist eine der Hauptursachen für bleibende Behinderungen. Daher hat die Primärprävention eines ersten Schlaganfalls eine hohe Priorität. Die Primärprävention des ischämischen Schlaganfalls umfasst die Änderung des Lebensstils und der Ernährung, die Behandlung von Risikofaktoren wie Bluthochdruck, Diabetes mellitus und Lipidstörungen, die Thrombozytenaggregationshemmung bei Patienten mit hohem Gefäßrisiko und die Antikoagulation bei Vorhofflimmern (AF). Zu den wichtigsten präventiven Strategien in der Primärprävention von Hirnblutungen gehören die Behandlung von Bluthochdruck, die Reduzierung des Alkoholkonsums und der Verschluss des linken Vorhofohrs bei Patienten mit Vorhofflimmern und dauerhafte Kontraindikationen für eine orale Antikoagulation.

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Carotid Endarterectomy versus Carotid Stenting or Best Medical Treatment in Asymptomatic Patients with Significant Carotid Stenosis: A meta-analysis

Cited by 23 publications

References 31 publications

Carotid Endarterectomy Versus Carotid Artery Stenting: Survey of the Quality, Readability, and Treatment Preference of Carotid Artery Disease Websites

Carotid Endarterectomy Versus Carotid Artery Stenting: Survey of the Quality, Readability, and Treatment Preference of Carotid Artery Disease Websites

Treatment strategies for asymptomatic carotid artery stenosis in the era of lipid-lowering drugs: protocol for a systematic review and network meta-analysis

Primärprävention des Schlaganfalls

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