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#121
31.08.2010, 18:06
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#122
31.08.2010, 18:35
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Цитата:
С уважением, Лев. P.s. "уже подрытых" или тех, которые вот-вот "подроются"?
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#124
31.08.2010, 20:37
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С уважением, Лев.
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#125
31.08.2010, 22:37
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#127
28.09.2010, 09:16
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ACST-1
Доложены 10-летние результаты одного из ключевых исследований по каротидной эндартерэктомии.
[Ссылки доступны только зарегистрированным пользователям ] Findings 1560 patients were allocated immediate CEA versus 1560 allocated deferral of any carotid procedure. The proportions operated on while still asymptomatic were 89·7% versus 4·8% at 1 year (and 92·1% vs 16·5% at 5 years). Perioperative risk of stroke or death within 30 days was 3·0% (95% CI 2·4—3·9; 26 non-disabling strokes plus 34 disabling or fatal perioperative events in 1979 CEAs). Excluding perioperative events and non-stroke mortality, stroke risks (immediate vs deferred CEA) were 4·1% versus 10·0% at 5 years (gain 5·9%, 95% CI 4·0—7·8) and 10·8% versus 16·9% at 10 years (gain 6·1%, 2·7—9·4); ratio of stroke incidence rates 0·54, 95% CI 0·43—0·68, p<0·0001. 62 versus 104 had a disabling or fatal stroke, and 37 versus 84 others had a non-disabling stroke. Combining perioperative events and strokes, net risks were 6·9% versus 10·9% at 5 years (gain 4·1%, 2·0—6·2) and 13·4% versus 17·9% at 10 years (gain 4·6%, 1·2—7·9). Medication was similar in both groups; throughout the study, most were on antithrombotic and antihypertensive therapy. Net benefits were significant both for those on lipid-lowering therapy and for those not, and both for men and for women up to 75 years of age at entry (although not for older patients). Interpretation Successful CEA for asymptomatic patients younger than 75 years of age reduces 10-year stroke risks. Half this reduction is in disabling or fatal strokes. Net benefit in future patients will depend on their risks from unoperated carotid lesions (which will be reduced by medication), on future surgical risks (which might differ from those in trials), and on whether life expectancy exceeds 10 years. PS. Вот бы полный текст..
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#128
28.09.2010, 09:21
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Мета-анализ исследований по стентированию против КЭЭ у симптомных пациентов
В Lancet опубликован мета-анализ, ([Ссылки доступны только зарегистрированным пользователям ]) в который вошли EVA-3S, SPACE и ICSS.
Findings In the first 120 days after randomisation (ITT analysis), any stroke or death occurred significantly more often in the carotid stenting group (153 [8·9%] of 1725) than in the carotid endarterectomy group (99 [5·8%] of 1708, risk ratio [RR] 1·53, [95% CI 1·20—1·95], p=0·0006; absolute risk difference 3·2 [1·4—4·9]). Of all subgroup variables assessed, only age significantly modified the treatment effect: in patients younger than 70 years (median age), the estimated 120-day risk of stroke or death was 50 (5·8%) of 869 patients in the carotid stenting group and 48 (5·7%) of 843 in the carotid endarterectomy group (RR 1·00 [0·68—1·47]); in patients 70 years or older, the estimated risk with carotid stenting was twice that with carotid endarterectomy (103 [12·0%] of 856 vs 51 [5·9%] of 865, 2·04 [1·48—2·82], interaction p=0·0053, p=0·0014 for trend). In the PP analysis, risk estimates of stroke or death within 30 days of treatment among patients younger than 70 years were 43 (5·1%) of 851 patients in the stenting group and 37 (4·5%) of 821 in the endarterectomy group (1·11 [0·73—1·71]); in patients 70 years or older, the estimates were 87 (10·5%) of 828 patients and 36 (4·4%) of 824, respectively (2·41 [1·65—3·51]; categorical interaction p=0·0078, trend interaction p=0·0013]. Interpretation Stenting for symptomatic carotid stenosis should be avoided in older patients (age ≥70 years), but might be as safe as endarterectomy in younger patients.
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#129
13.10.2010, 08:02
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Meta-Analysis: Carotid Stenting Tied to Higher Intermediate, Long-Term Risks Than Surgery
* Key Points: * Meta-analysis finds greater risk of stroke or death for carotid stenting vs. endarterectomy * Risk not only periprocedural but also longer term * Outside experts contend that statistically jumbled, outdated trials blur interpretation By L.A. McKeown Tuesday, October 12, 2010 Carotid artery stenting (CAS) is associated with higher intermediate- and long-term risk of stroke or death compared with carotid endarterectomy (CEA), suggests a new meta-analysis published online October 11, 2010, ahead of print in Archives of Neurology. However, the study also showed a significant reduction in periprocedural myocardial infarction (MI) and cranial nerve palsies with CAS.
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#130
28.10.2010, 09:27
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Неудобные вопросы авторам CREST ([Ссылки доступны только зарегистрированным пользователям ]
1. Целесообразность включения ИМ в конечную точку без надлежащего учета церебральной эмболии (ну нет у неврологов мозгового "тропонина"). 2. Группа CEA получала плавикс + аспирин, что могло повлиять на частоту ИМ и в целом на конечную точку. 3. Нет сравнения хирургического подхода с оптимальной медикаментозной терапией.
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#131
22.12.2010, 16:14
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CEA vs CAS в рутинной американской практике
"Boston, MA - After adjustment for symptom and risk status, carotid stenting results in higher rates of stroke and death when compared with surgical endarterectomy in the general US population, according to the results of a new study [[Ссылки доступны только зарегистрированным пользователям ]]. Mortality and stroke rates were significantly higher for carotid artery stenting than endarterectomy in high-risk and non-high-risk patients, report investigators"
[Ссылки доступны только зарегистрированным пользователям ]
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#132
22.12.2010, 16:56
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Цитата:
 Опять же вопрос насколько часто использовались protection devices в CAS? (Как назло сдохли все ходы к сайнс директу...)
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#133
22.12.2010, 17:04
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#134
23.12.2010, 12:29
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#135
23.12.2010, 16:33
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Линейный вид
