OBJECTIVES: The aim of the study was to analyse variation in carotid surgical practice, results and effectiveness in nine countries. PATIENTS AND METHODS: A total of 48,185 carotid endarterectomies (CEAs) and 4602 carotid artery stenting (CAS) procedures were included in the comparison. A theoretical effectiveness of CEA provision for each country was estimated. RESULTS: 92.6% of the CEAs were performed according to the inclusion criteria based on the current European recommendations and had a theoretical benefit for the patient. The indication for surgery was symptomatic stenosis in 60.1% and this proportion varied between 31.4% in Italy and 100% in Denmark. The overall combined stroke and death rate in symptomatic patients was 2.3%. This varied between rates of 0.9% in Italy and 3.8% in Norway. The overall combined stroke and death rate in asymptomatic patients was 0.9%. It was lowest in Italy at 0.5%, and highest in Sweden at 2.7%. We estimated that the stroke prevention rate per 1000 CEAs varied from 72.9 in Italy to 130.8 in Denmark. CONCLUSIONS: There is significant variation in clinical practice across the participating countries. The theoretical stroke prevention potential of CEA seems to vary between participating countries due to differences in the inclusion criteria.
OBJECTIVES: The aim of the study was to analyse variation in carotid surgical practice, results and effectiveness in nine countries. PATIENTS AND METHODS: A total of 48,185 carotid endarterectomies (CEAs) and 4602 carotid artery stenting (CAS) procedures were included in the comparison. A theoretical effectiveness of CEA provision for each country was estimated. RESULTS: 92.6% of the CEAs were performed according to the inclusion criteria based on the current European recommendations and had a theoretical benefit for the patient. The indication for surgery was symptomatic stenosis in 60.1% and this proportion varied between 31.4% in Italy and 100% in Denmark. The overall combined stroke and death rate in symptomatic patients was 2.3%. This varied between rates of 0.9% in Italy and 3.8% in Norway. The overall combined stroke and death rate in asymptomatic patients was 0.9%. It was lowest in Italy at 0.5%, and highest in Sweden at 2.7%. We estimated that the stroke prevention rate per 1000 CEAs varied from 72.9 in Italy to 130.8 in Denmark. CONCLUSIONS: There is significant variation in clinical practice across the participating countries. The theoretical stroke prevention potential of CEA seems to vary between participating countries due to differences in the inclusion criteria.
Authors: Francisco S Lozano; Josep Marinello; Rosa M Moreno; Maria D Aguilar; Alfonso López-Quintana; Jose R Gonzalez-Porras; Javier Alvarez; Antonio Giménez-Gaibar; Rafael Alguacil; Marc A Cairols; Miguel A Marco-Luque; Fernando Vaquero; José M Callejas Journal: World J Surg Date: 2014-01 Impact factor: 3.352
Authors: Donald V Heck; Gary S Roubin; Kenneth G Rosenfield; William A Gray; Christopher J White; Tudor G Jovin; Jon S Matsumura; Brajesh K Lal; Barry T Katzen; Guilherme Dabus; Brian T Jankowitz; Thomas G Brott Journal: Neurology Date: 2017-04-26 Impact factor: 9.910
Authors: Hans-Henning Eckstein; Pavlos Tsantilas; Andreas Kühnl; Bernhard Haller; Thorben Breitkreuz; Alexander Zimmermann; Michael Kallmayer Journal: Dtsch Arztebl Int Date: 2017-10-27 Impact factor: 5.594
Authors: John D Birkmeyer; Bradley N Reames; Peter McCulloch; Andrew J Carr; W Bruce Campbell; John E Wennberg Journal: Lancet Date: 2013-09-28 Impact factor: 79.321
Authors: Kosmas I Paraskevas; Dimitri P Mikhailidis; Hediyeh Baradaran; Alun H Davies; Hans-Henning Eckstein; Gianluca Faggioli; Jose Fernandes E Fernandes; Ajay Gupta; Mateja K Jezovnik; Stavros K Kakkos; Niki Katsiki; M Eline Kooi; Gaetano Lanza; Christos D Liapis; Ian M Loftus; Antoine Millon; Andrew N Nicolaides; Pavel Poredos; Rodolfo Pini; Jean-Baptiste Ricco; Tatjana Rundek; Luca Saba; Francesco Spinelli; Francesco Stilo; Sherif Sultan; Clark J Zeebregts; Seemant Chaturvedi Journal: J Stroke Date: 2021-05-31 Impact factor: 6.967