Evidence map›Paper›PMID 31378071›Full record

SynthesisCirculation. Cardiovascular interventions2019

Secular Trends in Procedural Stroke or Death Risks of Stenting Versus Endarterectomy for Symptomatic Carotid Stenosis.

Mandy D Müller, Stefanie von Felten, Ale Algra, Jean-Pierre Becquemin, Richard Bulbulia, David Calvet, Hans-Henning Eckstein, Gustav Fraedrich, Alison Halliday, Jeroen Hendrikse and 8 more

2 registry-linked trialsOpen access · bronzeAbstract readMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Circulation. Cardiovascular interventions, 2019. 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 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 pooled it
1.9field-weighted citation impact, top 13% 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.

NCT00004732 nacompletednot on this map

Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST)

TypeinterventionalSponsorRutgers, The State University of New JerseyRan2000 to 2016Enrolled2,502ConditionsAtherosclerosis, Stroke, Carotid Stenosis, Cerebral InfarctionArmsCarotid Endarterectomy (CEA), Carotid Artery Stenting (CAS)
NCT00190398 phase3completednot on this map

Endarterectomy Versus Angioplasty in Patients With Severe Symptomatic Carotid Stenosis

TypeinterventionalSponsorAssistance Publique - Hôpitaux de ParisRan2000 to 2009Enrolled900ConditionsTransient Ischemic Attack, Carotid Stenosis, AtherosclerosisArmsCarotid angioplasty and stenting with cerebral protection
3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it, 19 citations in OpenAlex.

  1. Pooled it
  2. Review
  3. Article
  4. Article
  5. Article
  6. Article
  7. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors at 11 institutions in 6 countries.

Mandy D MüllerDepartment of Neurology and Stroke Center (M.D.M. and L.H.B.), University Hospital Basel, University of Basel, Switzerland.
Stefanie von FeltenDepartment of Clinical Research, Clinical Trial Unit (S.v.F.), University Hospital Basel, University of Basel, Switzerland.
Ale AlgraDepartment of Neurology and Neurosurgery, Brain Center Rudolf Magnus and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht University, the Netherlands.
Jean-Pierre BecqueminVascular Institute Paris East, Hôpital privé Paul D'Egine, Ramsay Group, Champigny sur Marne, France (J.-P.B.).
Richard BulbuliaClinical Trial Service Unit and Epidemiological Studies Unit (R.B.), Nuffield Department of Population Health, University of Oxford, United Kingdom.
David CalvetDepartment of Neurology, Hôpital Sainte-Anne, Université Paris-Descartes, DHU Neurovasc Sorbonne Paris Cité, INSERM U894, France (D.C., J.-L.M.).
Hans-Henning EcksteinDepartment of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Germany (H.-H.E.).
Gustav FraedrichDepartment of Vascular Surgery, Medical University of Innsbruck, Austria (G.F.).
Alison HallidayNuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford, United Kingdom (A.H.).
Jeroen HendrikseDepartment of Radiology (J.H.), University Medical Center Utrecht, Utrecht University, the Netherlands.
George HowardDepartment of Biostatistics, UAB School of Public Health, Birmingham, AL (G.H.).
John GregsonDepartment of Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom (J.G.).
Olav JansenClinic for Radiology and Neuroradiology, Universitätsklinikum Schleswig-Holstein Campus Kiel, Germany (O.J.).
Martin M BrownDepartment of Brain Repair and Rehabilitation, Stroke Research Centre, UCL Queen Square Institute of Neurology, University College London, United Kingdom (M.M.B., L.H.B.).
Jean-Louis MasDepartment of Neurology, Hôpital Sainte-Anne, Université Paris-Descartes, DHU Neurovasc Sorbonne Paris Cité, INSERM U894, France (D.C., J.-L.M.).
Thomas G BrottDepartment of Neurology, Mayo Clinic, Jacksonville, FL (T.G.B.).
Peter A RinglebDepartment of Neurology, University of Heidelberg Medical School, Germany (P.A.R.).
Leo H BonatiDepartment of Neurology and Stroke Center (M.D.M. and L.H.B.), University Hospital Basel, University of Basel, Switzerland.
Alabama Department of Public Health · USHeidelberg University · DEInnsbruck Medical University · ATInserm · FRJohn Radcliffe Hospital · GBKlinikum rechts der Isar · DELondon School of Hygiene & Tropical Medicine · GBMayo Clinic in Florida · USMedical Research Council · GBSorbonne Paris Cité · FRUniversity of Basel · CH

Funding

CREST-2 Clinical Coordinating CenterU01NS080168 · NINDS · MAYO CLINIC JACKSONVILLE · PI Thomas G Brott, JAMES F MESCHIA · 2014 to 2026
$56.3M
CREST-2 Statistical and Data Coordinating Center - SDCCU01NS080165 · NINDS · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI EDWARDS, LLOYD J · 2014 to 2025
$15.0M
Department of HealthMedical Research Council G0300411NINDS NIH HHS U01 NS080165NINDS NIH HHS U01 NS080168
6 · The paper itself

Abstract

backgroundOver the past decades, stroke risk associated with carotid disease has decreased, reflecting improvements in medical therapy and a more rigorous control of vascular risk factors. It is less clear whether the procedural risk of carotid revascularization has declined over time.

methodsWe analyzed temporal changes in procedural risks among 4597 patients with symptomatic carotid stenosis treated with carotid artery stenting (n=2326) or carotid endarterectomy (n=2271) in 4 randomized trials between 2000 and 2008, using generalized linear mixed-effects models with a random intercept for each source trial. Models were additionally adjusted for age and other baseline characteristics predicting treatment risk. The primary outcome event was any procedural stroke or death, occurring during or within 30 days after revascularization.

resultsThe procedural stroke or death risk decreased significantly over time in all patients (unadjusted odds ratio per year, 0.91; 95% CI, 0.85-0.97; P=0.006). This effect was driven by a decrease in the carotid endarterectomy group (unadjusted odds ratio per year, 0.82; 95% CI, 0.73-0.92; P=0.003), whereas no significant decrease was found after carotid artery stenting (unadjusted odds ratio, 0.96; 95% CI, 0.88-1.04; P=0.33). Carotid endarterectomy patients had a lower procedural stroke or death risk compared with carotid artery stenting patients, and the difference significantly increased over time (interaction P=0.031). After adjustment for baseline characteristics, the results remained essentially the same.

conclusionsThe risk of stroke or death associated with carotid endarterectomy for symptomatic carotid stenosis decreased over an 8-year period, independent of clinical predictors of procedural risk. No corresponding reduction in procedural risk was seen in patients treated with stenting. CLINICAL

trial registrationURL: https://www.clinicaltrials.gov; http://www.isrctn.com. Unique identifier: NCT00190398 (EVA-3S), NCT00004732 (CREST), ISRCTN57874028 (SPACE), and ISRCTN25337470 (ICSS).

Indexed as

AgedCarotid StenosisEndarterectomy, CarotidEndovascular ProceduresFemaleHumansMaleMiddle AgedRandomized Controlled Trials as TopicRisk AssessmentRisk FactorsStentsStrokeTime FactorsTreatment Outcomecarotid stenosisendarterectomyhumansrisk factorsstents

Identifiers

PMID31378071
PMCPMC6823842
OpenAlexW2968453320

What Socratic holds

Textmetadata
LicenceTDM
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.