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dc.contributor.authorEmmanuel Touzéen_US
dc.contributor.authorLudovic Trinquarten_US
dc.contributor.authorRui Felgueirasen_US
dc.contributor.authorKittipan Rerkasemen_US
dc.contributor.authorLeo H. Bonatien_US
dc.contributor.authorGayané Meliksetyanen_US
dc.contributor.authorPeter A. Ringleben_US
dc.contributor.authorJean Louis Masen_US
dc.contributor.authorMartin M. Brownen_US
dc.contributor.authorPeter M. Rothwellen_US
dc.date.accessioned2018-09-04T09:32:16Z-
dc.date.available2018-09-04T09:32:16Z-
dc.date.issued2013-12-01en_US
dc.identifier.issn15244628en_US
dc.identifier.issn00392499en_US
dc.identifier.other2-s2.0-84889262737en_US
dc.identifier.other10.1161/STROKEAHA.113.002756en_US
dc.identifier.urihttps://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84889262737&origin=inwarden_US
dc.identifier.urihttp://cmuir.cmu.ac.th/jspui/handle/6653943832/52785-
dc.description.abstractBACKGROUND AND PURPOSE - Compared with carotid endarterectomy (CEA), carotid angioplasty and stenting (CAS) is associated with a higher risk of procedural stroke or death especially in patients with symptomatic stenosis. However, after the perioperative period, risk is similar with both treatments, suggesting that CAS could be an acceptable option in selected patients. METHODS - We performed systematic reviews of observational studies of procedural risks of CEA or CAS and extracted data on 9 predefined risk factors (age, contralateral carotid occlusion, coronary artery disease, diabetes mellitus, sex, hypertension, peripheral artery disease, and type and side of stenosis). We calculated pooled relative risks of procedural stroke or death. Factors with differential effects on risk of CAS versus CEA were identified by interaction tests and used to derive a rule. The rule was tested using individual patient data from randomized trials of CAS versus CEA from the Carotid Stenting Trialists' Collaboration (CSTC). RESULTS - We identified 170 studies. The effects of sex, contralateral occlusion, age, and restenosis (SCAR) on the procedural risk of stroke or death differed. Patients with contralateral occlusion or restenosis and women <75 years were at relatively low risk for CAS (SCAR negative), with all others being high risk (SCAR positive). Among the 3049 patients in the CSTC validation, 694 (23%) patients were SCAR negative. The pooled RR of procedural stroke and death with CAS versus CEA was 0.93 (0.49-1.77; P=0.83) in SCAR-negative and 2.41 (1.68-3.45; P<0.0001) in SCAR-positive patients (P [interaction]=0.05). CONCLUSIONS - The SCAR rule is potentially useful to identify patients in whom CAS has a similar risk of perioperative stroke or death to CEA. © 2013 American Heart Association, Inc.en_US
dc.subjectMedicineen_US
dc.subjectNursingen_US
dc.titleA clinical rule (sex, contralateral occlusion, age, and restenosis) to select patients for stenting versus carotid endarterectomy: Systematic review of observational studies with validation in randomized trialsen_US
dc.typeJournalen_US
article.title.sourcetitleStrokeen_US
article.volume44en_US
article.stream.affiliationsUniversite Paris Descartesen_US
article.stream.affiliationsUniversite de Caen Normandieen_US
article.stream.affiliationsUniversité Paris Descartesen_US
article.stream.affiliationsHopital de l'Hotel-Dieu CHU Lyonen_US
article.stream.affiliationsHospital Geral de Santo Antonioen_US
article.stream.affiliationsChiang Mai Universityen_US
article.stream.affiliationsUniversitatsspital Baselen_US
article.stream.affiliationsUCL Institute of Neurologyen_US
article.stream.affiliationsUniversitatsklinikum Heidelbergen_US
article.stream.affiliationsUniversity of Oxforden_US
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