Evidence map›Paper›PMID 34695552›Full record

Trial reportJournal of vascular surgery2022

Treatment of carotid stenosis in asymptomatic, nonoctogenarian, standard risk patients with stenting versus endarterectomy trials.

Jon S Matsumura, Bret M Hanlon, Kenneth Rosenfield, Jenifer H Voeks, George Howard, Gary S Roubin, Thomas G Brott

Open access · bronzeAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of vascular surgery, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 5 pooled it
2.1field-weighted citation impact, top 12% 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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 5 syntheses or guidelines pooled it, 19 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. CIRSE Standards of Practice on Carotid Artery Stenting.Cardiovascular and interventional radiology · 2024
    Guideline
  4. Pooled it
  5. Pooled it
  6. Article
  7. Article
  8. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors at 6 institutions in 1 country.

Jon S MatsumuraDepartment of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisc. Electronic address: matsumura@surgery.wisc.edu.
Bret M HanlonDepartment of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisc.
Kenneth RosenfieldMassachusetts General Hospital, Boston, Mass.
Jenifer H VoeksDepartment of Neurology, Medical University of South Carolina, Charleston, SC.
George HowardDepartment of Biostatistics, University of Alabama at Birmingham, Birmingham, Ala.
Gary S RoubinCardiovascular Associates of the Southeast, Birmingham, Ala.
Thomas G BrottMayo Clinic, Jacksonville, Fla.
University of Wisconsin–Madison · USCardiovascular Research Associates · USMassachusetts General Hospital · USMedical University of South Carolina · USUniversity of Alabama at Birmingham · USWinnMed · US

Funding

Carotid Revascularization Endarterectomy vs Stenting TrialR01NS038384 · NINDS · UNIV OF MED/DENT OF NJ-NJ MEDICAL SCHOOL · PI BROTT, THOMAS G · 1999 to 2010
$40.7M
NINDS NIH HHS R01 NS038384
6 · The paper itself

Abstract

objectiveAsymptomatic carotid stenosis is the most frequent indication for carotid endarterectomy (CEA) in the United States. Published trials and guidelines support CEA indications in selected patients with longer projected survival and when periprocedural complications are low. Transfemoral carotid artery stenting with embolic protection (CAS) is a newer treatment option. The objective of this study was to compare outcomes in asymptomatic, nonoctogenarian patients treated with CAS vs CEA.

methodsPatient-level data was analyzed from 2544 subjects with ≥70% asymptomatic carotid stenosis who were randomized to CAS or CEA in addition to standard medical therapy. One trial enrolled 1091 (548 CAS, 543 CEA) and another enrolled 1453 (1089 CAS, 364 CEA) asymptomatic patients less than 80 years old (upper age eligibility). Independent neurologic assessment and routine cardiac enzyme screening were performed. The prespecified, primary composite endpoint was any stroke, myocardial infarction, or death during the periprocedural period or ipsilateral stroke within 4 years after randomization.

resultsThere was no significant difference in the primary endpoint between CAS and CEA (5.3% vs 5.1%; hazard ratio, 1.02; 95% confidence interval, 0.7-1.5; P = .91). Periprocedural rates for the components are (CAS vs CEA): any stroke (2.7% vs 1.5%; P = .07), myocardial infarction (0.6% vs 1.7%; P = .01), death (0.1% vs 0.2%; P = .62), and any stroke or death (2.7% vs 1.6%; P = .07). After this period, the rates of ipsilateral stroke were similar (2.3% vs 2.2%; P = .97).

conclusionsIn a pooled analysis of two large randomized trials of CAS and CEA in asymptomatic, nonoctogenarian patients, CAS achieves comparable short- and long-term results to CEA.

Indexed as

Carotid StenosisEndarterectomy, CarotidMyocardial InfarctionStrokeAged, 80 and overHumansRisk AssessmentRisk FactorsStentsTreatment OutcomeUnited StatesCarotidCarotid stenosisEndarterectomyRandom allocationStents

Identifiers

PMID34695552
PMCPMC9365439
OpenAlexW3209912058

What Socratic holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

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.