Download presentation
Presentation is loading. Please wait.
Published byAddison Musgraves Modified over 10 years ago
1
Πόσο σίγουροι είμαστε για το όφελος της ενδαρτηρεκτομής; Γεώργιος Ντάιος Παθολογική Κλινική & Ομώνυμο Ερευνητικό Εργαστήριο Ιατρική Σχολή Πανεπιστημίου Θεσσαλίας Heart Vessels Stroke Αthens, 27-01-2013
2
Disclosures Support to attend conferences: Bayer; Sanofi-Aventis; Pfizer; Lundbeck; Boehringer-Ingelheim; Bristol Myers Squibb; Galenica. Honoraria: Quintiles; CHUV. Scholarships: European Stroke Organization; Hellenic Society of Atherosclerosis. National coordinator (Greece) for the ENOS trial.
4
JAMA 1995; 273:1421-1428
5
ACAS: Asymptomatic Carotid Artery Study JAMA 1995; 273:1421-1428 5.1% 11%
6
Lancet 2004; 363: 1491–502
7
ACST: Asymptomatic Carotid Surgery Trial Lancet 2004; 363: 1491–502
8
ACST: Asymptomatic Carotid Surgery Trial Lancet 2004; 363: 1491–502
9
Stroke 2011; 42(8):e464-540
10
It is reasonable to perform carotid endarterectomy in asymptomatic patients with >70% internal carotid artery stenosis if the risk of perioperative stroke, MI, and death is low. (Level A, Class IIb) Stroke 2011; 42(8):e464-540
11
ACST: Asymptomatic Carotid Surgery Trial Lancet 2004; 363: 1491–502
12
Number-Needed-to-Treat: 40 (to prevent 1 stroke in 5 years)
14
Best (???) medical treatment
16
Lancet 1996; 348: 1329–39
17
CAPRIE: Clopidogrel vs. Aspirin Lancet 1996; 348: 1329–39
18
Lancet 2006; 367: 1665–73
19
ESPRIT: Aggrenox vs. Aspirin Lancet 2006; 367: 1665–73
20
Best (???) medical treatment - Better antiplatelets are available now
21
ACST: Asymptomatic Carotid Surgery Trial Lancet 2004; 363: 1491–502
22
ACST: Asymptomatic Carotid Surgery Trial Lancet 2004; 363: 1491–502
23
Stroke 2008; 39: 3297–3302
25
Best (???) medical treatment - Better antiplatelets are available now - 30% did not receive statin
26
Stroke 2009; 40:e573– e583
28
Excellent safety record an annual minimum of 12 carotid endarterectomies mortality/morbidity rate <3% in the last 50 cases. 40% of initial applicants were rejected 2 strokes/deaths temporarily suspended ACAS: Asymptomatic Carotid Artery Study
29
Subgroup analysis ?
30
ACST: Asymptomatic Carotid Surgery Trial Lancet 2004; 363: 1491–502
31
Stroke 2004; 35:2425-2427
32
Lancet 2005; 365:176-86
36
Subgroup analysis
37
Risk stratification ?
38
Degree of stenosis Stroke 2000; 31:615-621
39
Plaque surface
40
Stroke 2011; 42:972-978 Total plaque area
41
Stroke 2006; 37:818-823
42
Radiology 2009; 252: 502-8
43
Intraplaque hemorrhage Radiology 2009; 252: 502-8
44
Lancet Neurol 2010; 9: 663–71 Microembolic signals
45
Lancet Neurol 2010; 9: 663–71
46
Microembolic signals Lancet Neurol 2010; 9: 663–71
48
Silent strokes J Vasc Surg 2009;49:902-9
49
Silent strokes J Vasc Surg 2009;49:902-9
50
Risk stratification -Degree of stenosis -Plaque surface -Total plaque area -Fibrous cap -Intraplaque hemorrhage -Microemboli -Silent strokes
51
Take home messages
Similar presentations
© 2025 SlidePlayer.com. Inc.
All rights reserved.