The Efficacy of Carotid Surgery by Subgroups : The Concept of Stroke Prevention Potential

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Aro , E , Ijas , P , Vikatmaa , L , Soinne , L , Sund , R , Venermo , M & Vikatmaa , P 2019 , ' The Efficacy of Carotid Surgery by Subgroups : The Concept of Stroke Prevention Potential ' , European Journal of Vascular and Endovascular Surgery , vol. 58 , no. 1 , pp. 5-12 . https://doi.org/10.1016/j.ejvs.2019.04.003

Title: The Efficacy of Carotid Surgery by Subgroups : The Concept of Stroke Prevention Potential
Author: Aro, Ellinoora; Ijas, Petra; Vikatmaa, Leena; Soinne, Lauri; Sund, Reijo; Venermo, Maarit; Vikatmaa, Pirkka
Contributor: University of Helsinki, HUS Abdominal Center
University of Helsinki, HUS Neurocenter
University of Helsinki, HUS Perioperative, Intensive Care and Pain Medicine
University of Helsinki, Clinicum
University of Helsinki, Doctoral Programme in Social Sciences
University of Helsinki, Verisuonikirurgian yksikkö
University of Helsinki, HUS Abdominal Center
Date: 2019-07
Language: eng
Number of pages: 8
Belongs to series: European Journal of Vascular and Endovascular Surgery
ISSN: 1078-5884
URI: http://hdl.handle.net/10138/312993
Abstract: Objective: Considering carotid endarterectomy (CEA), reporting treatment delay, symptom status, and surgical complication rates separately gives an incomplete picture of efficacy; therefore, the aim was to combine these factors and develop a reporting standard that better describes the number of potentially prevented strokes. With a real life cohort and theoretical inclusion scenarios, the aim was to explore the stroke prevention potential of different carotid practices. Methods: Landmark studies for symptomatic and asymptomatic patients were revisited. By using published estimates of treatment effect, a simplified calculator was designed to assess the five year stroke prevention rate per 1000 CEAs (stroke prevention potential [SPP], range 0-478), including the presence and recentness of symptoms, sex, increasing stenosis severity, and complication rates. Patients operated on for carotid stenosis at Helsinki University Hospital (HUH) between 2008 and 2016 were collected from a vascular registry (HUSVASC) and categorised according to the model. The local annual complication rate was re-evaluated and added to the model. The HUH patient cohort was incorporated into the SPP model, and changes over time analysed. Finally, theoretical changes in patient selection were compared in order to explore the theoretical impact of patient selection and shortening of the delay. Results: Fifteen hundred and five symptomatic and 356 asymptomatic carotid stenoses were operated on with stroke plus death rates of 3.6% and 0.3%, respectively. The proportion of CEAs performed within two weeks of the index event increased over the follow up period, being 77% in 2016. The SPP increased from 123 in 2008 to 229 in 2016. Theoretically, 350 ischaemic strokes were prevented in the period 2008-16, with 1861 CEAs. Conclusions: National and international comparison of different CEA series is irrelevant if the inclusion criteria are not considered. A calculator that is easy to apply to large scale high quality registered data was developed and tested. SPP was found to increase over time, which is a probable sign of improved patient selection and an increased number of strokes prevented by the CEAs performed.
Subject: Benchmarking
Carotid endarterectomy
Registries
Secondary prevention
Stroke
Treatment outcome
Vascular diseases
TRANSIENT ISCHEMIC ATTACK
EDITORS CHOICE
SYMPTOMATIC PATIENTS
ARTERY STENOSIS
ENDARTERECTOMY
RISK
TIME
REVASCULARIZATION
MULTICENTER
GUIDELINES
3126 Surgery, anesthesiology, intensive care, radiology
BENCHMARKING
Carotid endarterectomy
REGISTRIES
SECONDARY PREVENTION
STROKE
Vascular Diseases
TREATMENT OUTCOME
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