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Risk of Recurrent Stroke in Patients with Symptomatic Mild (20-49% NASCET) Carotid Artery Stenosis

Artikel i vetenskaplig tidskrift
Författare Lena Karlsson
Elisabeth Kangefjärd
S. Hermansson
S Strömberg
Klas Österberg
A Nordanstig
Mikael Ryndel
Karl Gellerman
Johan Fredén Lindqvist
Göran Bergström
Publicerad i European Journal of Vascular and Endovascular Surgery
Volym 52
Nummer/häfte 3
Sidor 287-294
ISSN 1078-5884
Publiceringsår 2016
Publicerad vid Wallenberglaboratoriet
Institutionen för neurovetenskap och fysiologi, sektionen för klinisk neurovetenskap och rehabilitering
Institutionen för medicin
Sidor 287-294
Språk en
Länkar dx.doi.org/10.1016/j.ejvs.2016.05.0...
Ämnesord Mild, Symptomatic, Carotid artery stenosis, Recurrent stroke, transient ischemic attack, duplex ultrasonography, endarterectomy, moderate, surgery, trial, Surgery, Cardiovascular System & Cardiology
Ämneskategorier Klinisk medicin

Sammanfattning

Objective: The objective of this study was to evaluate the risk of recurrent ischaemic stroke in patients with ultrasound assessed symptomatic mild carotid artery stenosis (20-49% NASCET) treated solely with modern medical treatment. Method: This was a retrospective, observational register cohort study. Three groups of patients were recruited from a database of all carotid Doppler ultrasound examinations performed in the Gothenburg region between 2004 and 2009. Patients with symptomatic mild carotid artery stenosis (n = 162) were compared with patients with asymptomatic carotid artery stenosis (n = 301) of equal degree and a group of patients with surgically (CEA) treated symptomatic moderate or severe carotid artery stenosis (n = 220). Kaplan-Meier estimates and Cox proportional hazard models were used to compare the primary outcome (ipsilateral ischaemic stroke) between groups. Results: After a 3 year follow up, the cumulative incidence of recurrent ipsilateral stroke in patients with symptomatic mild carotid artery stenosis was 7.4%. Patients with symptomatic mild carotid artery stenosis had a substantially increased risk of recurrent ipsilateral stroke compared with asymptomatic patients with equal degree of stenosis (HR 5.5. 95% CI 1.8-17.1; p = .003) as also compared with patients with CEA treated symptomatic moderate or severe stenosis (HR 7.8. 95% CI 1.62-37.8; p = .011). Conclusions: The present study on patients with symptomatic mild carotid artery stenosis, as determined by Doppler ultrasound, shows that there is still a substantial risk of recurrent stroke in this group. (C) 2016 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

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