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8 - Interventional management of carotid disease

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Published online by Cambridge University Press:  03 December 2009

Andrew G. Clifton
Affiliation:
St George's Hospital, London SW17 0QT, UK
Jonathan Gillard
Affiliation:
University of Cambridge
Martin Graves
Affiliation:
University of Cambridge
Thomas Hatsukami
Affiliation:
University of Washington
Chun Yuan
Affiliation:
University of Washington
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Summary

Surgical trials and the role of surgery

Stroke is the third most common cause of death in the Western world, and atherosclerotic stenosis of the carotid artery, close to the carotid bifurcation in the neck, causes about 10% of all strokes and transient ischemic attacks (TIA) (Clifton, 2002). For patients who have had recent symptoms associated with severe carotid stenosis the additional risk of stroke over the next 2 years is thought to be 20% or more if patients are treated medically and is thought to be greater in patients with very severe stenosis (Dennis et al., 1990). It may be as high as 28% (North American Symptomatic Carotid Endarterectomy Trial Collaborators, 1991). Recent studies have shown, however, that the risks may be greater. The Oxford Community Stroke Project showed that much data looks at risk of stroke from either the date seen by a neurologist or from the date referred to at TIA service. They showed that the risk of stroke from the date of the first ever TIA was much greater in the first 30 days, in the region of 12%+ (Coull et al., 2004). It has also been shown that the odds of having a stroke when the patient is found to have large artery disease, i.e. significant carotid stenosis, is much greater than if the cause is found to be secondary to small vessel disease or cardiac embolism (Lovett et al., 2003).

Type
Chapter
Information
Carotid Disease
The Role of Imaging in Diagnosis and Management
, pp. 94 - 104
Publisher: Cambridge University Press
Print publication year: 2006

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