Your SlideShare is downloading. ×
0
下載
下載
下載
下載
下載
下載
下載
下載
下載
下載
下載
下載
下載
下載
下載
下載
下載
下載
下載
下載
下載
下載
下載
下載
下載
下載
下載
下載
下載
下載
下載
下載
下載
下載
下載
下載
下載
下載
下載
下載
下載
下載
下載
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

下載

201

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
201
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
2
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Percutaneous transluminal angioplasty and stenting for carotid artery stenosis (Review) Ederle J, Featherstone RL, Brown MM. Percutaneous transluminal angioplasty and stenting for carotid artery stenosis. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD000515. DOI: 10.1002/14651858.CD000515.pub3. 外科部 R1 廖國鈞
  • 2. Patient Profile <ul><li>75-year-old woman </li></ul><ul><li>26908236, 蘇太太 </li></ul><ul><li>Medical history: 1. Hypertension for six years 2. TIA two years ago </li></ul><ul><li>Diagnosis: 1. TIA 2. Moderate stenosis of right carotid artery 3. hypertension </li></ul>
  • 3. STROKE. 2006;37:577-617.
  • 4. <ul><li>P: patient with carotid stenosis </li></ul><ul><li>I: carotid angioplasty </li></ul><ul><li>C: carotid endarterectomy </li></ul><ul><li>O: prognosis, recurrent stroke </li></ul>
  • 5.  
  • 6.  
  • 7. BACKGROUND <ul><li>Endovascular treatment by transluminal balloon angioplasty or stent insertion may be a useful alternative to carotid endarterectomy </li></ul>
  • 8. OBJECTIVE <ul><li>To assess the benefits and risks of endovascular treatment compared with carotid endarterectomy or medical therapy. </li></ul>
  • 9. SEARCH STRATEGY <ul><li>Cochrane Stroke Group trials register (last searched 14 March 2007) and the following bibliographic databases: </li></ul><ul><li>1. Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1, 2007) </li></ul><ul><li>2. MEDLINE (1950 to March 2007) </li></ul><ul><li>3. EMBASE (1980 to March 2007) </li></ul><ul><li>4. Science Citation Index (1945 to March 2007) </li></ul>
  • 10. SELECTION CRITERIA <ul><li>randomised trials of endovascular treatment compared with endarterectomy or medical therapy for carotid artery stenosis. </li></ul>
  • 11. DATA COLLECTION AND ANALYSIS <ul><li>One review author independently applied the inclusion criteria, extracted data and assessed trial quality. Search results were validated by a second review author. </li></ul>
  • 12. MAIN RESULTS <ul><li>Data were available from 12 trials (3227 patients) but not all contributed to each analysis. </li></ul><ul><li>any stroke or death within 30 days of treatment favoured surgery (odds ratio (OR) 1.39, P = 0.02, not significant (NS) in the random-effects model). </li></ul><ul><li>favoured endovascular treatment over surgery: </li></ul><ul><li>1. cranial neuropathy (OR 0.07, P < 0.01); </li></ul><ul><li>2. 30 day neurological complication or death (OR 0.62, P = 0.004, NS in the random-effects model, with significant heterogeneity). </li></ul>
  • 13. <ul><li>little difference between endovascular treatment and surgery: </li></ul><ul><li>1. 30 day stroke </li></ul><ul><li>2. myocardial infarction or death (OR 1.11, P = 0.57 with significant heterogeneity) </li></ul><ul><li>3. stroke during long-term follow up (OR 1.00) </li></ul>
  • 14. endovascular treatment with or without protection device showed no significant difference in 30 day stroke or death (OR 0.77, P = 0.42 with significant heterogeneity).
  • 15. Analysis of stroke or death within 30 days of the procedure in asymptomatic carotid stenosis showed no difference (OR 1.06, P = 0.96).
  • 16. AUTHORS’ CONCLUSION <ul><li>The data are difficult to interpret because the trials are heterogeneous (different patients, endovascular procedures, and duration of follow up) and five trials were stopped early, perhaps leading to an over-estimate of the risks of endovascular treatment. </li></ul><ul><li>The pattern of effects on different outcomes does not support a change in clinical practice away from recommending carotid endarterectomy as the treatment of choice for suitable carotid artery stenosis. </li></ul>
  • 17. <ul><li>This review, which included 12 trials involving 3227 participants, showed that surgery might be better than endovascular treatment in preventing early stroke or death, but there were fewer immediate neurological complications with endovascular treatment than with surgery. </li></ul><ul><li>During follow-up, the risk of stroke or death was similar after endarterectomy compared to endovascular treatment. Treated arteries may be more likely to narrow down after endovascular treatment than after carotid endarterectomy. </li></ul>
  • 18. Thank you for attention
  • 19.  
  • 20.  
  • 21.  
  • 22.  
  • 23.  
  • 24.  
  • 25.  
  • 26.  
  • 27.  
  • 28.  
  • 29.  
  • 30.  
  • 31.  
  • 32.  
  • 33.  
  • 34. CAROTID ANGIOPLASTYWITHORWITHOUT STENT PLACEMENTVERSUS CAROTID ENDARTERECTOMY FOR TREATMENTOF CAROTID STENOSIS:A META-ANALYSIS <ul><li>OBJECTIVE: Carotid angioplasty with or without stent placement (CAS): an alternative method to carotid endarterectomy (CEA) </li></ul><ul><li>Small randomized trials have evaluated the comparative efficacy of both methods </li></ul><ul><li>definitive evidence is lacking. </li></ul>
  • 35. METHODS <ul><li>A search was made for randomized clinical trials comparing CAS and CEA </li></ul><ul><li>A meta-analysis was performed using a random effects model because significant heterogeneity was observed. </li></ul><ul><li>Outcomes compared included 1-month composite rates of stroke or death, all strokes, disabling strokes, myocardial infarction, cranial nerve injury, and major bleeding and 1-year rates of both minor and major ipsilateral strokes. </li></ul>
  • 36. IDENTIFICATION AND CRITERIA FOR INCLUSION OF TRIALS IN THE REVIEW <ul><li>The trials were identified by an electronic database search (MEDLINE, PubMed, and Cochrane databases from 1990 to 2003). Electronic search terms included: carotid stenosis, carotid endarterectomy, carotid stent, and carotid angioplasty. </li></ul><ul><li>These terms were cross-referenced with prospective study, controlled trial, and randomization. </li></ul>
  • 37. METHODS OF THE REVIEW AND QUALITY ASSESSMENT OF TRIALS <ul><li>The scale grades the quality of three items describing randomization (0–2 points), double blinding (0–2 points), and dropouts and withdrawals (0–1 point). A higher score indicates better reporting. </li></ul>
  • 38.  
  • 39.  
  • 40.  
  • 41.  
  • 42.  
  • 43.  

×