Clotilde Balucani1, Vanessa Arnedo1, Jeremy Weedon2, Didier Leys3, Jean-Louis Mas4, Martin Brown5, James C Grotta6, Nicole R Gonzales7, Werner Hacke8, Thomas Brott9, Steven R Levine1. 1. The Department of Neurology and Stroke Center, Downstate Medical Center, The State University of New York, SUNY, Brooklyn, New York, NY, USA. 2. The Department of Public Health, SUNY Downstate Medical Center, Brooklyn, New York, NY, USA. 3. The Department of Neurology, Lille University Hospital, Lille, France. 4. Neurology Department and Stroke Unit, INSERM UMR S 894, Sainte-Anne Hospital, Paris Descartes University, Paris, France. 5. The Stroke Research Group, UCL Institute of Neurology, London, UK. 6. Stroke Research, Memorial Hermann Hospital, Houston, TX, USA. 7. The Department of Neurology, UTHealth Medical School, Houston, TX, USA. 8. The Department of Neurology, Heidelberg, Germany. 9. The Department of Neurology, The Mayo Clinic, Jacksonville, FL, USA.
Abstract
BACKGROUND AND PURPOSE: Management of carotid stenosis remains controversial despite several trials evaluating carotid endarterectomy (CEA) and carotid angioplasty/stenting (CAS). We compared attitudes in the management of carotid stenosis between selected experts within Europe and North America. METHODS: A 3-phase Delphi survey was e-mailed to select stroke experts from Europe (n = 390) and North America (n = 289). Those completing the initial survey were shown all responses after each survey round. Consensus was defined as ≥80% agreement. RESULTS: For phases 1, 2, and 3, response rates were 32%, 62%, and 73%, respectively. Overall, 100 (15%) of 679 participated in all 3 phases, 19% Europeans versus 9% North Americans (P = .0007). The European group reached consensus in 6 of 15 statements; The North American group reached consensus in 4 of 15. Ninety percentage of Europeans versus 70% of North Americans (P = .017) stated CEA is superior to CAS for symptomatic carotid stenosis. This difference was not significant in the final model (adjusted odds ratio: 3.72 [95% confidence interval: 0.95-14.5]). Sixty-nine percentage of North Americans agreed there is a stronger indication for CAS over CEA in patients younger than 65 years for symptomatic carotid stenosis, whereas 55% of Europeans (P = .023) disagreed. For asymptomatic carotid stenosis, when asked how likely they would recommend CAS, 62% North Americans said "sometimes" versus 60% of Europeans said "never" (P = .06). CONCLUSION: The majority of North American and European respondents did not consider the 2 procedures equivalent and seemed to indicate that CEA was preferred for the management of carotid stenosis. These findings need to be further explored to help establish evidence-based guidelines.
BACKGROUND AND PURPOSE: Management of carotid stenosis remains controversial despite several trials evaluating carotid endarterectomy (CEA) and carotid angioplasty/stenting (CAS). We compared attitudes in the management of carotid stenosis between selected experts within Europe and North America. METHODS: A 3-phase Delphi survey was e-mailed to select stroke experts from Europe (n = 390) and North America (n = 289). Those completing the initial survey were shown all responses after each survey round. Consensus was defined as ≥80% agreement. RESULTS: For phases 1, 2, and 3, response rates were 32%, 62%, and 73%, respectively. Overall, 100 (15%) of 679 participated in all 3 phases, 19% Europeans versus 9% North Americans (P = .0007). The European group reached consensus in 6 of 15 statements; The North American group reached consensus in 4 of 15. Ninety percentage of Europeans versus 70% of North Americans (P = .017) stated CEA is superior to CAS for symptomatic carotid stenosis. This difference was not significant in the final model (adjusted odds ratio: 3.72 [95% confidence interval: 0.95-14.5]). Sixty-nine percentage of North Americans agreed there is a stronger indication for CAS over CEA in patients younger than 65 years for symptomatic carotid stenosis, whereas 55% of Europeans (P = .023) disagreed. For asymptomatic carotid stenosis, when asked how likely they would recommend CAS, 62% North Americans said "sometimes" versus 60% of Europeans said "never" (P = .06). CONCLUSION: The majority of North American and European respondents did not consider the 2 procedures equivalent and seemed to indicate that CEA was preferred for the management of carotid stenosis. These findings need to be further explored to help establish evidence-based guidelines.
Authors: Michal Tendera; Victor Aboyans; Marie-Louise Bartelink; Iris Baumgartner; Denis Clément; Jean-Philippe Collet; Alberto Cremonesi; Marco De Carlo; Raimund Erbel; F Gerry R Fowkes; Magda Heras; Serge Kownator; Erich Minar; Jan Ostergren; Don Poldermans; Vincent Riambau; Marco Roffi; Joachim Röther; Horst Sievert; Marc van Sambeek; Thomas Zeller Journal: Eur Heart J Date: 2011-08-26 Impact factor: 29.983
Authors: Anne L Abbott; Mark A Adelman; Andrei V Alexandrov; P Alan Barber; Henry J M Barnett; Jonathan Beard; Peter Bell; Martin Björck; David Blacker; Leo H Bonati; Martin M Brown; Clifford J Buckley; Richard P Cambria; John E Castaldo; Anthony J Comerota; E Sander Connolly; Ronald L Dalman; Alun H Davies; Hans-Henning Eckstein; Rishad Faruqi; Thomas E Feasby; Gustav Fraedrich; Peter Gloviczki; Graeme J Hankey; Robert E Harbaugh; Eitan Heldenberg; Michael G Hennerici; Michael D Hill; Timothy J Kleinig; Dimitri P Mikhailidis; Wesley S Moore; Ross Naylor; Andrew Nicolaides; Kosmas I Paraskevas; David M Pelz; James W Prichard; Grant Purdie; Jean-Baptiste Ricco; Peter A Ringleb; Thomas Riles; Peter M Rothwell; Peter Sandercock; Henrik Sillesen; J David Spence; Francesco Spinelli; Jonathon Sturm; Aaron Tan; Ankur Thapar; Frank J Veith; Tissa Wijeratne; Wei Zhou Journal: Stroke Date: 2013-03-19 Impact factor: 7.914