Evidence map›Paper›PMID 25453443›Full record

Trial reportLancet (London, England)2015

Long-term outcomes after stenting versus endarterectomy for treatment of symptomatic carotid stenosis: the International Carotid Stenting Study (ICSS) randomised trial.

Leo H Bonati, Joanna Dobson, Roland L Featherstone, Jörg Ederle, H Bart van der Worp, Gert J de Borst, Willem P Th M Mali, Jonathan D Beard, Trevor Cleveland, Stefan T Engelter and 5 more

2 registry-linked trialsOpen access · hybridAbstract readComparative StudyMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Lancet (London, England), 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 167 papers, 12 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
167citing papers in PubMed, 12 pooled it
33.8field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03507374 early_phase1terminatedstarted 2018, after this paper: background citation

PCSK9 Inhibition in Patients With Symptomatic Intracranial Atherosclerosis

Ran2018Enrolled20Registered outcomes5Posted comparisons0ConditionsIntracranial Atherosclerosis, Intraplaque Hemorrhage, StrokeArmsAlirocumab, Placebo
PMID 25854637PMID 25790886PMID 25307297PMID 25040677PMID 24958153PMID 24741562PMID 24135208PMID 23988640PMID 23463579PMID 23404720PMID 22872053PMID 21958949other papers from this trial
Open the trial in the graph
NCT05907629 recruitingnot on this mapstarted 2024, after this paper: background citation

Comparison of Anti-coagulation and Anti-Platelet Therapies for Intracranial Vascular Atherostenosis- Magnetic Resonance Imaging

TypeobservationalSponsorYale UniversityRan2024 to 2029Enrolled300ConditionsStroke, Intracranial Atherosclerotic Stenosis (ICAS)ArmsMRI
3 · Its place in the literature

Who cites it

167 citing papers in PubMed, 12 syntheses or guidelines pooled it, 535 citations in OpenAlex.

  1. Pooled it
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  4. CIRSE Standards of Practice on Carotid Artery Stenting.Cardiovascular and interventional radiology · 2024
    Guideline
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  13. Trial
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  18. Cost-utility analysis of stenting versus endarterectomy in the International Carotid Stenting Study.International journal of stroke : official journal of the International Stroke Society · 2016
    Trial
  19. Long-Term Results of Stenting versus Endarterectomy for Carotid-Artery Stenosis.The New England journal of medicine · 2016 · on this map
    Trial
  20. Carotid Anatomy Does Not Predict the Risk of New Ischaemic Brain Lesions on Diffusion-Weighted Imaging after Carotid Artery Stenting in the ICSS-MRI Substudy.European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery · 2016
    Trial

107 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

15 authors at 7 institutions in 3 countries.

Leo H BonatiDepartment of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, London, UK; Department of Neurology and Stroke Unit, University Hospital Basel, Basel University, Basel, Switzerland.
Joanna DobsonDepartment of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK.
Roland L FeatherstoneDepartment of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, London, UK.
Jörg EderleDepartment of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, London, UK.
H Bart van der WorpDepartment of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands.
Gert J de BorstDepartment of Vascular Surgery, University Medical Center Utrecht, Utrecht, Netherlands.
Willem P Th M MaliDepartment of Radiology, University Medical Center Utrecht, Utrecht, Netherlands.
Jonathan D BeardSheffield Vascular Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
Trevor ClevelandSheffield Vascular Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
Stefan T EngelterDepartment of Neurology and Stroke Unit, University Hospital Basel, Basel University, Basel, Switzerland.
Philippe A LyrerDepartment of Neurology and Stroke Unit, University Hospital Basel, Basel University, Basel, Switzerland.
Gary A FordStroke Research Group, Newcastle University, Newcastle upon Tyne, UK.
Paul J DormanDepartment of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
Martin M BrownDepartment of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, London, UK. Electronic address: martin.brown@ucl.ac.uk.
International Carotid Stenting Study investigators
University College London · GBUniversity Hospital of Basel · CHUniversity Medical Center Utrecht · NLSheffield Teaching Hospitals NHS Foundation Trust · GBLondon School of Hygiene & Tropical Medicine · GBNewcastle University · GBRoyal Victoria Infirmary · GB

Funding

Medical Research Council G0300411
6 · The paper itself

Abstract

backgroundStenting is an alternative to endarterectomy for treatment of carotid artery stenosis, but long-term efficacy is uncertain. We report long-term data from the randomised International Carotid Stenting Study comparison of these treatments.

methodsPatients with symptomatic carotid stenosis were randomly assigned 1:1 to open treatment with stenting or endarterectomy at 50 centres worldwide. Randomisation was computer generated centrally and allocated by telephone call or fax. Major outcomes were assessed by an independent endpoint committee unaware of treatment assignment. The primary endpoint was fatal or disabling stroke in any territory after randomisation to the end of follow-up. Analysis was by intention to treat ([ITT] all patients) and per protocol from 31 days after treatment (all patients in whom assigned treatment was completed). Functional ability was rated with the modified Rankin scale. This study is registered, number ISRCTN25337470.

findings1713 patients were assigned to stenting (n=855) or endarterectomy (n=858) and followed up for a median of 4·2 years (IQR 3·0-5·2, maximum 10·0). Three patients withdrew immediately and, therefore, the ITT population comprised 1710 patients. The number of fatal or disabling strokes (52 vs 49) and cumulative 5-year risk did not differ significantly between the stenting and endarterectomy groups (6·4% vs 6·5%; hazard ratio [HR] 1·06, 95% CI 0·72-1·57, p=0·77). Any stroke was more frequent in the stenting group than in the endarterectomy group (119 vs 72 events; ITT population, 5-year cumulative risk 15·2% vs 9·4%, HR 1·71, 95% CI 1·28-2·30, p<0·001; per-protocol population, 5-year cumulative risk 8·9% vs 5·8%, 1·53, 1·02-2·31, p=0·04), but were mainly non-disabling strokes. The distribution of modified Rankin scale scores at 1 year, 5 years, or final follow-up did not differ significantly between treatment groups.

interpretationLong-term functional outcome and risk of fatal or disabling stroke are similar for stenting and endarterectomy for symptomatic carotid stenosis.

fundingMedical Research Council, Stroke Association, Sanofi-Synthélabo, European Union.

Indexed as

Endarterectomy, CarotidStentsAgedCarotid StenosisFemaleFollow-Up StudiesHumansMaleMiddle AgedRecovery of FunctionStrokeTime FactorsTreatment Outcome

Identifiers

PMID25453443
PMCPMC4322188
OpenAlexW2109652445

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.