Occam's razor: Intervene early to prevent more strokes!

Journal of Vascular Surgery
A R Naylor

Abstract

The early risk of stroke after a patient suffers a transient ischemic attack (TIA)/minor stroke is significantly higher than previously thought. In most health systems, this (unfortunately) means that many vulnerable patients will have suffered their stroke before having had any chance of being considered for carotid endarterectomy (CEA) or carotid angioplasty with stenting (CAS). The problem is then compounded by institutional delays in finally undertaking CEA/CAS, which leads to even greater diminishing benefit to the patient. Notwithstanding the fact that the international trials used a 6-month threshold for inclusion, it remains an unpalatable fact that if CEA/CAS is delayed beyond 12 weeks in symptomatic patients with North American Symptomatic Carotid Endarterectomy Trial (NASCET) 50% to 99% stenoses, the patient is exposed to all of the risks of intervening, but gains little in the way of long-term stroke prevention. The take-home message is, therefore, very simple; "intervene early to prevent more strokes". Occam's razor has never been sharper!

References

Jan 15, 2003·European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery·R HuberW Sandmann
Jan 18, 2003·Lancet·P M RothwellUNKNOWN Carotid Endarterectomy Trialists' Collaboration
Oct 2, 2003·Annals of Neurology·S Claiborne JohnstonHarold P Adams
Jan 14, 2004·Journal of Vascular Surgery·Philip S K PatyDhiraj M Shah
Mar 27, 2004·Lancet·P M RothwellUNKNOWN Carotid Endarterectomy Trialists Collaboration
Jan 29, 2005·Current Neurology and Neuroscience Reports·Mai N Nguyen-Huynh, S Claiborne Johnston
Mar 9, 2005·Neurology·Peter M Rothwell, Charles P Warlow
Mar 21, 2006·Lancet Neurology·Peter M RothwellS Claiborne Johnston
Jun 15, 2006·European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery·E SbarigiaP Fiorani
Feb 23, 2007·The Surgeon : Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland·A Ross Naylor
Jun 2, 2007·European Journal of Neurology : the Official Journal of the European Federation of Neurological Societies·R TopakianF T Aichner
Jun 5, 2007·Journal of Vascular Surgery·Christos D KarkosA Ross Naylor
Aug 3, 2007·Interactive Cardiovascular and Thoracic Surgery·Walter DorigoCarlo Pratesi
Oct 2, 2007·Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association·Barbara RantnerGustav Fraedrich
Nov 13, 2007·Lancet Neurology·Matthew F Giles, Peter M Rothwell
Nov 30, 2007·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·William A GrayUNKNOWN CAPTURE Trial Collaborators
May 9, 2008·Annals of Vascular Surgery·Hernan A BazanAlan Dardik

❮ Previous
Next ❯

Citations

Jan 26, 2017·Vascular and Endovascular Surgery·Carlos A HinojosaArmando Gamboa-Domínguez
Feb 27, 2014·The Korean Journal of Thoracic and Cardiovascular Surgery·Jong Hun KimJa Hong Kuh
Feb 2, 2011·Stroke; a Journal of Cerebral Circulation·Thomas G BrottUNKNOWN American Academy of Neurology and Society of Cardiovascular Computed Tomography
Feb 2, 2011·Stroke; a Journal of Cerebral Circulation·Thomas G BrottUNKNOWN American Academy of Neurology and Society of Cardiovascular Computed Tomography
Jul 14, 2010·ANZ Journal of Surgery·Manar KhashramDavid R Lewis
Oct 13, 2010·Expert Review of Cardiovascular Therapy·Umar SadatJonathan H Gillard
Feb 23, 2020·The Journal of Cardiovascular Surgery·R Clement Darling
Jun 19, 2016·Postgraduate Medical Journal·Michael G NannaCarlos Mena
Apr 8, 2021·Angiologii︠a︡ i sosudistai︠a︡ khirurgii︠a︡ = Angiology and vascular surgery·N R ZakirzhanovV V Evseeva

❮ Previous
Next ❯

Related Concepts

Related Feeds

Carotid Artery Diseases

Carotid artery disease is a group of pathological conditions of the carotid artery. Discover the latest research on carotid artery disease here.