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Titolo:
GUIDELINES FOR CAROTID ENDARTERECTOMY - A MULTIDISCIPLINARY CONSENSUSSTATEMENT FROM THE AD-HOC-COMMITTEE, AMERICAN-HEART-ASSOCIATION
Autore:
MOORE WS; BARNETT HJM; BEEBE HG; BERNSTEIN EF; BRENER BJ; BROTT T; CAPLAN LR; DAY A; GOLDSTONE J; HOBSON RW; KEMPCZINSKI RF; MATCHAR DB; MAYBERG MR; NICOLAIDES AN; NORRIS JW; RICOTTA JJ; ROBERTSON JT; RUTHERFORD RB; THOMAS D; TOOLE JF; TROUT HH; WIEBERS DO;
Indirizzi:
AMER HEART ASSOC,OFF SCI AFFAIRS,7272 GREENVILLE AVE DALLAS TX 75231
Titolo Testata:
Circulation
fascicolo: 2, volume: 91, anno: 1995,
pagine: 566 - 579
SICI:
0009-7322(1995)91:2<566:GFCE-A>2.0.ZU;2-A
Fonte:
ISI
Lingua:
ENG
Soggetto:
CORONARY-ARTERY BYPASS; TRANSIENT ISCHEMIC ATTACKS; SIMULTANEOUS MYOCARDIAL REVASCULARIZATION; ASYMPTOMATIC ULCERATIVE LESIONS; CONCOMITANT OCCLUSIVE DISEASE; COMBINED SURGICAL APPROACH; LARGE METROPOLITAN AREA; TERM FOLLOW-UP; NATURAL-HISTORY; CEREBROVASCULAR-DISEASE;
Keywords:
CAROTID ENDARTERECTOMY; STROKE; CLINICAL TRIALS; CONSENSUS STATEMENT; SURGERY;
Tipo documento:
Review
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
174
Recensione:
Indirizzi per estratti:
Citazione:
W.S. Moore et al., "GUIDELINES FOR CAROTID ENDARTERECTOMY - A MULTIDISCIPLINARY CONSENSUSSTATEMENT FROM THE AD-HOC-COMMITTEE, AMERICAN-HEART-ASSOCIATION", Circulation, 91(2), 1995, pp. 566-579

Abstract

Background and Purpose Indications for carotid endarterectomy have engendered considerable debate among experts and have resulted in publication of retrospective reviews, natural history studies, audits of community practice, position papers, expert opinion statements, and finally prospective randomized trials. The American Heart Association assembled a group of experts in a multidisciplinary consensus conference todevelop this statement. Methods A conference was held July 16-18, 1993, in Park City, Utah, that included recognized experts in neurology, neurosurgery, vascular surgery, and healthcare planning. A program of critical topics was developed, and each expert presented a talk and provided the chairman with a summary statement. From these summary statements a document was developed and edited onsite to achieve consensus before final revision. Results The first section of this document reviews the natural history, methods of patient evaluation, options for medical management, results of surgical management, data from position statements, and results to date of prospective randomized trials for symptomatic and asymptomatic patients with carotid artery disease. The second section divides 96 potential indications for carotid endarterectomy, based on surgical risk, into four categories: (1) Proven: This isthe strongest indication for carotid endarterectomy; data are supported by results of prospective contemporary randomized trials. (2) Acceptable but not proven: a good indication for operation; supported by promising but not scientifically certain data. (3) Uncertain: Data are insufficient to define the risk/benefit ratio. (4) Proven inappropriate: Current data are adequate to show that the risk of surgery outweighsany benefit. Conclusions Indications for carotid endarterectomy in symptomatic good-risk patients with a surgeon whose surgical morbidity and mortality rate is less than 6% are as follows. (1) Proven: one or more TIAs in the past 6 months and carotid stenosis greater than or equal to 70% or mild stroke within 6 months and a carotid stenosis greater than or equal to 70%; (2) acceptable but not proven: TIAs within thepast 6 months and a stenosis 50% to 69%, progressive stroke and a stenosis greater than or equal to 70%, mild or moderate stroke in the past 6 months and a stenosis 50% to 69%, or carotid endarterectomy ipsilateral to TIAs and a stenosis greater than or equal to 70% combined with required coronary artery bypass grafting; (3) uncertain: TIAs with astenosis <50%, mild stroke and stenosis <50%, TIAs with a stenosis <70% combined with coronary artery bypass grafting, or symptomatic, acute carotid thrombosis; (4) proven inappropriate: moderate stroke with stenosis <50%,, not on aspirin; single TIA, <50% stenosis, not on aspirin; high-risk patient with multiple TIAs, not on aspirin, stenosis <50%; high-risk patient, mild or moderate stroke, stenosis <50%, not on aspirin; global ischemic symptoms with stenosis <50%; acute dissection,asymptomatic on heparin. Indications for carotid endarterectomy in asymptomatic good-risk patients performed by a surgeon whose surgical morbidity and mortality rate is less than 3% are as follows. (1) Proven:none. As this statement went to press, the National Institute of Neurological Disorders and Stroke issued a clinical advisory stating that the Institute has halted the Asymptomatic Carotid Atherosclerosis Study (ACAS) because of a clear benefit in favor of surgery for patients with carotid stenosis greater than or equal to 60% as measured by diameter reduction. When the ACAS report is published, this indication willbe recategorized as proven. (2) acceptable but not proven: stenosis >75% by linear diameter; (3) uncertain: stenosis >75% in a high-risk patient/surgeon (surgical morbidity and mortality rate >3%), combined carotid/coronary operations, or ulcerative lesions without hemodynamically significant stenosis; (4) proven inappropriate: operations with a combined stroke morbidity and mortality >5%.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 02/04/20 alle ore 22:17:47