Immediate versus delayed treatment for recently symptomatic carotid artery stenosis

Show simple item record

dc.contributor.author Vasconcelos, Vladimir [UNIFESP]
dc.contributor.author Cassola, Nicolle [UNIFESP]
dc.contributor.author da Silva, Edina M. K.
dc.contributor.author Baptista-Silva, Jose C. C. [UNIFESP]
dc.date.accessioned 2019-01-21T10:29:41Z
dc.date.available 2019-01-21T10:29:41Z
dc.date.issued 2016
dc.identifier http://dx.doi.org/10.1002/14651858.CD011401.pub2
dc.identifier.citation Cochrane Database Of Systematic Reviews. Hoboken, n. 9, p. CD011401, 2016.
dc.identifier.issn 1469-493X
dc.identifier.uri http://repositorio.unifesp.br/handle/11600/49328
dc.description.abstract Background The timing of surgery for recently symptomatic carotid artery stenosis remains controversial. Early cerebral revascularization may prevent a disabling or fatal ischemic recurrence, but it may also increase the risk of hemorrhagic transformation, or of dislodging a thrombus. This review examined the randomized controlled evidence that addressed whether the increased risk of recurrent events outweighed the increased benefit of an earlier intervention. Objectives To assess the risks and benefits of performing very early cerebral revascularization (within two days) compared with delayed treatment (after two days) for people with recently symptomatic carotid artery stenosis. Search methods We searched the Cochrane Stroke Group Trials Register in January 2016, the Cochrane Central Register of Controlled Trials (CENTRAL en
dc.description.abstract The Cochrane Library 2016, Issue 1), MEDLINE (1948 to 26 January 2016), EMBASE (1974 to 26 January 2016), LILACS (1982 to 26 January 2016), and trial registers (from inception to 26 January 2016). We also handsearched conference proceedings and journals, and searched reference lists. There were no language restrictions. We contacted colleagues and pharmaceutical companies to identify further studies and unpublished trials. Selection criteria All completed, truly randomized trials (RCT) that compared very early cerebral revascularization (within two days) with delayed treatment (after two days) for people with recently symptomatic carotid artery stenosis. Data collection and analysis We independently selected trials for inclusion according to the above criteria, assessed risk of bias for each trial, and performed data extraction. We utilized an intention-to-treat analysis strategy. Main results We identified one RCT that involved 40 participants, and addressed the timing of surgery for people with recently symptomatic carotid artery stenosis. It compared very early surgery with surgery performed after 14 days of the last symptomatic event. The overall quality of the evidence was very low, due to the small number of participants from only one trial, and missing outcome data. We found no statistically significant difference between the effects of very early or delayed surgery in reducing the combined risk of stroke and death within 30 days of surgery (risk ratio (RR) 3.32 en
dc.description.abstract confidence interval (CI) 0.38 to 29.23 en
dc.description.abstract very low-quality evidence), or the combined risk of perioperative death and stroke (RR 0.47 en
dc.description.abstract CI 0.14 to 1.58 en
dc.description.abstract very low-quality evidence). To date, no results are available to confirm the optimal timing for surgery. Authors' conclusions There is currently no high-quality evidence available to support either very early or delayed cerebral revascularization after a recent ischemic stroke. Hence, further randomized trials to identify which patients should undergo very urgent revascularization are needed. Future studies should stratify participants by age group, sex, grade of ischemia, and degree of stenosis. Currently, there is one ongoing RCT that is examining the timing of cerebral revascularization. en
dc.description.sponsorship Cochrane Stroke Group, UK
dc.description.sponsorship Department of emergency Medicine of Universidade Federal de Sao Paulo, UNIFESP, Brazil
dc.description.sponsorship Brazilian Cochrane Center, Brazil
dc.format.extent CD011401
dc.language.iso eng
dc.publisher Hindawi Publishing Corp
dc.relation.ispartof Cochrane Database Of Systematic Reviews
dc.rights Acesso aberto
dc.subject Transient Ischemic Attack en
dc.subject Vascular-Surgery Guidelines en
dc.subject Procedural Risk en
dc.subject Flow Reversal en
dc.subject Acute Stroke en
dc.subject Endarterectomy en
dc.subject Multicenter en
dc.subject Metaanalysis en
dc.subject Evolution en
dc.subject Society en
dc.title Immediate versus delayed treatment for recently symptomatic carotid artery stenosis en
dc.type Revisão
dc.description.affiliation Department of Vascular Surgery, Universidade Federal de São Paulo, Rua Borges Lagoa 754, BR-04038001 Sao Paulo, Brazi
dc.description.affiliation Emergency Medicine and Evidence BasedMedicine, Universidade Federal de São Paulo, São Paulo, Brazil
dc.description.affiliation Evidence Base d Medicine, Cochrane Brazil, Universidade Federal deSão Paulo, São Paulo, Brazil
dc.description.affiliationUnifesp Department of Vascular Surgery, Universidade Federal de São Paulo, Rua Borges Lagoa 754, BR-04038001 Sao Paulo, Brazi
dc.description.affiliationUnifesp Emergency Medicine and Evidence BasedMedicine, Universidade Federal de São Paulo, São Paulo, Brazil
dc.description.affiliationUnifesp Evidence Base d Medicine, Cochrane Brazil, Universidade Federal deSão Paulo, São Paulo, Brazil
dc.identifier.file WOS000389599000018.pdf
dc.identifier.doi 10.1002/14651858.CD011401.pub2
dc.description.source Web of Science
dc.identifier.wos WOS:000389599000018



File

Name: WOS000389599000018.pdf
Size: 295.1Kb
Format: PDF
Description:
Open file

This item appears in the following Collection(s)

Show simple item record

Search


Browse

Statistics

My Account