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Trends and Outcomes of Carotid Arter...

Hussain, Mohamad Anas.

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Trends and Outcomes of Carotid Artery Revascularization in Ontario, Canada: A Population-Based Analysis.

紀錄類型:	書目-電子資源 : Monograph/item
正題名/作者:	Trends and Outcomes of Carotid Artery Revascularization in Ontario, Canada: A Population-Based Analysis./
作者:	Hussain, Mohamad Anas.
出版者:	Ann Arbor : ProQuest Dissertations & Theses, : 2018,
面頁冊數:	242 p.
附註:	Source: Dissertations Abstracts International, Volume: 80-02, Section: B.
Contained By:	Dissertations Abstracts International80-02B.
標題:	Medicine. -
電子資源:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=10690541
ISBN:	9780438186040

Trends and Outcomes of Carotid Artery Revascularization in Ontario, Canada: A Population-Based Analysis.
Hussain, Mohamad Anas.

Trends and Outcomes of Carotid Artery Revascularization in Ontario, Canada: A Population-Based Analysis. - Ann Arbor : ProQuest Dissertations & Theses, 2018 - 242 p.

Source: Dissertations Abstracts International, Volume: 80-02, Section: B.

Thesis (Ph.D.)--University of Toronto (Canada), 2018.

This item must not be sold to any third party vendors.

Introduction: Evidence for the safety and efficacy of carotid-artery stenting compared with endarterectomy is accumulating from randomized controlled trials. However, data on utilization trends and long-term outcomes of carotid revascularization strategies in real world practice are lacking. Methods: We first conducted a multicenter validation study to assess the accuracy of carotid-artery revascularization coding in Ontario health administrative databases. We then identified a retrospective population-based cohort of individuals who underwent carotid endarterectomy or stenting in Ontario, Canada (2002-2015). We used time-series analyses to examine temporal changes in the utilization rates of carotid revascularization procedures, and compared long-term (up to 13 years) and 30-day outcomes of carotid endarterectomy versus stenting overall and by operator specialty. Results: Carotid-artery revascularization procedures were coded with high accuracy in administrative databases (positive predictive value, 87-99%; sensitivity, 90-93%). Overall, 86% of patients underwent endarterectomy and 14% stenting. The rate of endarterectomy decreased by 36%, whereas carotid-artery stenting increased by 72% during the study period. Rate of the composite outcome of 30-day death, stroke or myocardial infarction plus any stroke during 13-year follow-up was higher with stenting (16.3%) compared with endarterectomy (9.7%) (adjusted hazard ratio, 1.57; 95% confidence interval, 1.43-1.73). In the endarterectomy group, the risk of 30-day stroke or death was higher among patients treated by non-vascular surgeons (4.0%) compared with vascular surgeons (2.9%) (adjusted odds ratio, 1.32; 95% confidence interval, 1.08-1.62). Operator specialty was not associated with adverse outcomes after carotid-artery stenting. Conclusions: Although the utilization of carotid-artery stenting has increased, stenting carries a 1.5-fold higher risk of long-term events compared to endarterectomy. Vascular surgeons appear to perform endarterectomy at the lowest event rates. While non-randomized, these results raise potential concerns about the interchangeability of carotid endarterectomy and stenting in the context of actual clinical practice, and may have implications for local referral practices and policies.

ISBN: 9780438186040Subjects--Topical Terms:

641104
Medicine.

Trends and Outcomes of Carotid Artery Revascularization in Ontario, Canada: A Population-Based Analysis.
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