A systematic review of the risks of stroke and death due to endarterectomy for symptomatic carotid stenosis.
BACKGROUND AND PURPOSE: Carotid endarterectomy reduces the risk of carotid territory ischemic stroke ipsilateral to a recently symptomatic severe carotid stenosis. However, the benefit is limited by the risks of stroke and death associated with the operation. Although reported surgical risks vary en...
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| Format: | Journal article |
| Language: | English |
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1996
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| _version_ | 1797051412338704384 |
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| author | Rothwell, P Slattery, J Warlow, C |
| author_facet | Rothwell, P Slattery, J Warlow, C |
| author_sort | Rothwell, P |
| collection | OXFORD |
| description | BACKGROUND AND PURPOSE: Carotid endarterectomy reduces the risk of carotid territory ischemic stroke ipsilateral to a recently symptomatic severe carotid stenosis. However, the benefit is limited by the risks of stroke and death associated with the operation. Although reported surgical risks vary enormously, there has been no systematic review of the published literature. METHODS: We performed a systematic review of mortality and the risk of stroke and/or death due to endarterectomy for symptomatic carotid stenosis in studies published since 1980. RESULTS: Fifty-one studies fulfilled our criteria. Overall mortality was 1.62% (95% confidence interval [CI], 1.3 to 1.9), and the risk of stroke and/or death was 5.64% (95% CI, 4.4 to 6.9). However, there was significant heterogeneity of risk of stroke and/or death (P < .001). The risk varied systematically with the methods and the authorship of the study. The risk of stroke and/or death was highest in studies in which patients were assessed by a neurologist after surgery (7.7%; 95% CI, 5.0 to 10.2) and lowest in studies with a single author affiliated with a department of surgery (2.3%; 95% CI, 1.8 to 2.7). After correcting for study methodology, there was no temporal trend in the risk of stroke and/or death between 1980 and 1995. CONCLUSIONS: The reported risks of endarterectomy for symptomatic carotid stenosis show significantly greater variability than would be expected by chance. However, much of this variability can be accounted for by differences in methodology and authorship. The 5.6% overall risk of stroke and/or death is consistent with present guidelines. |
| first_indexed | 2024-03-06T18:19:11Z |
| format | Journal article |
| id | oxford-uuid:05b014aa-c050-49b4-9656-2d47b6b0e092 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T18:19:11Z |
| publishDate | 1996 |
| record_format | dspace |
| spelling | oxford-uuid:05b014aa-c050-49b4-9656-2d47b6b0e0922022-03-26T08:58:28ZA systematic review of the risks of stroke and death due to endarterectomy for symptomatic carotid stenosis.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:05b014aa-c050-49b4-9656-2d47b6b0e092EnglishSymplectic Elements at Oxford1996Rothwell, PSlattery, JWarlow, CBACKGROUND AND PURPOSE: Carotid endarterectomy reduces the risk of carotid territory ischemic stroke ipsilateral to a recently symptomatic severe carotid stenosis. However, the benefit is limited by the risks of stroke and death associated with the operation. Although reported surgical risks vary enormously, there has been no systematic review of the published literature. METHODS: We performed a systematic review of mortality and the risk of stroke and/or death due to endarterectomy for symptomatic carotid stenosis in studies published since 1980. RESULTS: Fifty-one studies fulfilled our criteria. Overall mortality was 1.62% (95% confidence interval [CI], 1.3 to 1.9), and the risk of stroke and/or death was 5.64% (95% CI, 4.4 to 6.9). However, there was significant heterogeneity of risk of stroke and/or death (P < .001). The risk varied systematically with the methods and the authorship of the study. The risk of stroke and/or death was highest in studies in which patients were assessed by a neurologist after surgery (7.7%; 95% CI, 5.0 to 10.2) and lowest in studies with a single author affiliated with a department of surgery (2.3%; 95% CI, 1.8 to 2.7). After correcting for study methodology, there was no temporal trend in the risk of stroke and/or death between 1980 and 1995. CONCLUSIONS: The reported risks of endarterectomy for symptomatic carotid stenosis show significantly greater variability than would be expected by chance. However, much of this variability can be accounted for by differences in methodology and authorship. The 5.6% overall risk of stroke and/or death is consistent with present guidelines. |
| spellingShingle | Rothwell, P Slattery, J Warlow, C A systematic review of the risks of stroke and death due to endarterectomy for symptomatic carotid stenosis. |
| title | A systematic review of the risks of stroke and death due to endarterectomy for symptomatic carotid stenosis. |
| title_full | A systematic review of the risks of stroke and death due to endarterectomy for symptomatic carotid stenosis. |
| title_fullStr | A systematic review of the risks of stroke and death due to endarterectomy for symptomatic carotid stenosis. |
| title_full_unstemmed | A systematic review of the risks of stroke and death due to endarterectomy for symptomatic carotid stenosis. |
| title_short | A systematic review of the risks of stroke and death due to endarterectomy for symptomatic carotid stenosis. |
| title_sort | systematic review of the risks of stroke and death due to endarterectomy for symptomatic carotid stenosis |
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