MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis. European Carotid Surgery Trialists' Collaborative Group.

医学 冲程(发动机) 随机对照试验 动脉内膜切除术 外科 狭窄 颈动脉内膜切除术 心脏病学 机械工程 工程类
作者
Troels S. Jensen
出处
期刊:PubMed 卷期号:337 (8752): 1235-43 被引量:964
链接
标识
摘要

The European Carotid Surgery Trial is a multicentre trial of carotid endarterectomy for patients who, after a carotid territory non-disabling ischaemic stroke, transient ischaemic attack, or retinal infarct, are found to have a stenotic lesion in the relevant (ipsilateral) carotid artery. Over the past 10 years 2518 patients have been randomised, and the mean follow-up is now almost 3 years among the 2200 thus far available for analysis of the incidence of strokes that lasted more than 7 days. For the patients with "moderate" (30-69%) stenosis on their prerandomisation angiogram the balance of surgical risk and eventual benefit remains uncertain, and full recruitment continues. For 374 patients with only "mild" (0-29%) stenosis there was little 3-year risk of ipsilateral ischaemic stroke, even in the absence of surgery, so any 3-year benefits of surgery were small, and were outweighed by its early risks. For 778 patients with "severe" (70-99%) stenosis, however, the risks of surgery were significantly outweighed by the later benefits: although 7.5% had a stroke (or died) within 30 days of surgery, during the next 3 years the risks of ipsilateral ischaemic stroke were (by life-table analysis) an extra 2.8% for surgery-allocated and 16.8% for control patients (a sixfold reduction, p less than 0.0001). There was also a small reduction in other strokes, and at 3 years the total risk of surgical death, surgical stroke, ipsilateral ischaemic stroke, or any other stroke was 12.3% for surgery and 21.9% for control (difference 9.6% SD 3.3, 2p less than 0.01). The main concern was to avoid disabling or fatal events, and, among severe stenosis patients, 3.7% had a disabling stroke (or died) within 30 days of surgery, an extra 1.1% surgery versus 8.4% control (p less than 0.0001) had a disabling or fatal ipsilateral ischaemic stroke by 3 years, and the total 3-year risk of any disabling or fatal stroke (or surgical death) was 6.0% surgery versus 11.0% control (overall difference 5.0% SD 2.3, 2p less than 0.05); but, for disabling or fatal stroke the control risks seemed to diminish after the first year, so delay of surgery by just a few months after clinical presentation might make this overall difference non-significant.

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
鲸落发布了新的文献求助30
1秒前
葳葳完成签到,获得积分10
3秒前
sl发布了新的文献求助10
6秒前
6秒前
sanqian911完成签到,获得积分10
7秒前
昏睡的蟠桃应助liars采纳,获得150
8秒前
斯文败类应助荒野风采纳,获得10
8秒前
8秒前
hrzmlily完成签到,获得积分10
10秒前
顽主完成签到,获得积分10
11秒前
义气访曼完成签到 ,获得积分10
12秒前
时尚战斗机完成签到,获得积分10
12秒前
14秒前
亦玉完成签到,获得积分10
14秒前
Philadelphus完成签到,获得积分20
16秒前
16秒前
wsh完成签到 ,获得积分10
17秒前
luyue9406完成签到,获得积分10
17秒前
luochen完成签到,获得积分10
17秒前
酷波er应助奶黄包采纳,获得10
18秒前
ROMANTIC完成签到 ,获得积分10
18秒前
Hancock完成签到 ,获得积分10
19秒前
luyue9406发布了新的文献求助10
20秒前
Akim应助小王采纳,获得10
20秒前
甜蜜的楷瑞应助zqfxc采纳,获得10
22秒前
Hello应助花雨落123采纳,获得10
24秒前
25秒前
26秒前
柚仝完成签到 ,获得积分10
26秒前
贾明灵完成签到,获得积分10
26秒前
未来学术司马懿应助LIUYONG采纳,获得10
27秒前
Dops完成签到,获得积分10
29秒前
票子发布了新的文献求助10
30秒前
晚风完成签到 ,获得积分10
30秒前
坚强莺发布了新的文献求助10
30秒前
无奈曼云完成签到,获得积分10
31秒前
不会吹口哨完成签到,获得积分10
31秒前
易槐完成签到,获得积分10
32秒前
情怀应助和谐的梦蕊采纳,获得10
32秒前
33秒前
高分求助中
【提示信息,请勿应助】关于scihub 10000
Les Mantodea de Guyane: Insecta, Polyneoptera [The Mantids of French Guiana] 3000
徐淮辽南地区新元古代叠层石及生物地层 3000
The Mother of All Tableaux: Order, Equivalence, and Geometry in the Large-scale Structure of Optimality Theory 3000
Global Eyelash Assessment scale (GEA) 1000
Picture Books with Same-sex Parented Families: Unintentional Censorship 550
Research on Disturbance Rejection Control Algorithm for Aerial Operation Robots 500
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 4038426
求助须知:如何正确求助?哪些是违规求助? 3576119
关于积分的说明 11374556
捐赠科研通 3305834
什么是DOI,文献DOI怎么找? 1819339
邀请新用户注册赠送积分活动 892678
科研通“疑难数据库(出版商)”最低求助积分说明 815029