Imperial College London
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MrAnkurThapar

Faculty of Medicine, Department of Surgery & Cancer

Honorary Senior Lecturer
 
 
 
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Contact

 

a.thapar09

 
 
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Location

 

Charing Cross HospitalCharing Cross Campus

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Summary

 

Publications

Citation

BibTex format

@article{Munster:2015:10.1212/WNL.0000000000001781,
author = {Munster, AB and Franchini, AJ and Qureshi, MI and Thapar, A and Davies, AH},
doi = {10.1212/WNL.0000000000001781},
journal = {Neurology},
pages = {365--372},
title = {Temporal trends in safety of carotid endarterectomy in asymptomatic patients},
url = {http://dx.doi.org/10.1212/WNL.0000000000001781},
volume = {85},
year = {2015}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Objective: To systematically review temporal changes in perioperative safety of carotid endarterectomy (CEA) in asymptomatic individuals in trial and registry studies.Methods: The MEDLINE and EMBASE databases were searched using the terms “carotid” and “endarterectomy” and “asymptomatic” from 1947 to August 23, 2014. Articles dealing with 50%–99% stenosis in asymptomatic individuals were included and low-volume studies were excluded. The primary endpoint was 30-day stroke or death and the secondary endpoint was 30-day all-cause mortality. Statistical analysis was performed using random-effects meta-regression for registry data and for trial data graphical interpretation alone was used.Results: Six trials (n = 4,431 procedures) and 47 community registries (n = 204,622 procedures) reported data between 1983 and 2013. Registry data showed a significant decrease in postoperative stroke or death incidence over the period 1991–2010, equivalent to a 6% average proportional annual reduction (95% credible interval [CrI] 4%–7%; p < 0.001). Considering postoperative all-cause mortality, registry data showed a significant 5% average proportional annual reduction (95% CrI 3%–9%; p < 0.001). Trial data showed a similar visual trend.Conclusions: CEA is safer than ever before and high-volume registry results closely mirror the results of trials. New benchmarks for CEA are a stroke or death risk of 1.2% and a mortality risk of 0.4%. This information will prove useful for quality improvement programs, for health care funders, and for those re-examining the long-term benefits of asymptomatic revascularization in future trials.
AU  - Munster,AB
AU  - Franchini,AJ
AU  - Qureshi,MI
AU  - Thapar,A
AU  - Davies,AH
DO  - 10.1212/WNL.0000000000001781
EP  - 372
PY  - 2015///
SN  - 0028-3878
SP  - 365
TI  - Temporal trends in safety of carotid endarterectomy in asymptomatic patients
T2  - Neurology
UR  - http://dx.doi.org/10.1212/WNL.0000000000001781
UR  - http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000359343300010&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
UR  - http://hdl.handle.net/10044/1/43226
VL  - 85
ER  -
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