Evidence map›Paper›PMID 26160210›Full record

Trial reportEuropean journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery2015

Mechanism of Procedural Stroke Following Carotid Endarterectomy or Carotid Artery Stenting Within the International Carotid Stenting Study (ICSS) Randomised Trial.

A Huibers, D Calvet, F Kennedy, K R Czuriga-Kovács, R L Featherstone, F L Moll, M M Brown, T Richards, G J de Borst

Open access · hybridAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 35 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
35citing papers in PubMed, 2 pooled it
11.0field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

35 citing papers in PubMed, 2 syntheses or guidelines pooled it, 135 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Carotid artery stenting without embolic protection: A randomized multicenter trial (the CASWEP trial).Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences · 2023
    Trial
  4. Diastolic Blood Pressure is a Risk Factor for Peri-procedural Stroke Following Carotid Endarterectomy in Asymptomatic Patients.European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery · 2017
    Trial
  5. Predictors of Stroke, Myocardial Infarction or Death within 30 Days of Carotid Artery Stenting: Results from the International Carotid Stenting Study.European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery · 2016
    Trial
  6. Article
  7. Article
  8. Article
  9. Article
  10. Review
  11. Article
  12. Article
  13. Article
  14. Article
  15. Perioperative stroke.Nature reviews. Disease primers · 2024
    Review
  16. Article
  17. Article
  18. Article
  19. Article
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 4 institutions in 4 countries.

A HuibersDepartment of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK; Department of Vascular Surgery, University Medical Centre Utrecht, The Netherlands.
D CalvetDepartment of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK; Centre de Psychiatrie et Neurosciences, INSERM UMR 894, Paris Descartes University, Paris, France; Department of Neurology, Centre hospitalier Sainte-Anne, Paris, France.
F KennedyDepartment of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK.
K R Czuriga-KovácsDepartment of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK; Department of Neurology, Clinical Center, University of Debrecen, Debrecen, Hungary.
R L FeatherstoneDepartment of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK.
F L MollDepartment of Vascular Surgery, University Medical Centre Utrecht, The Netherlands.
M M BrownDepartment of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK. Electronic address: martin.brown@ucl.ac.uk.
T RichardsDepartment of Surgical and Interventional Sciences, University College London, London, UK.
G J de BorstDepartment of Vascular Surgery, University Medical Centre Utrecht, The Netherlands.
University College London · GBUniversity Medical Center Utrecht · NLInserm · FRUniversity of Debrecen · HU

Funding

Department of HealthMedical Research Council G0300411
6 · The paper itself

Abstract

objectiveTo decrease the procedural risk of carotid revascularisation it is crucial to understand the mechanisms of procedural stroke. This study analysed the features of procedural strokes associated with carotid artery stenting (CAS) and carotid endarterectomy (CEA) within the International Carotid Stenting Study (ICSS) to identify the underlying pathophysiological mechanism. MATERIALS AND

methodsPatients with recently symptomatic carotid stenosis (1,713) were randomly allocated to CAS or CEA. Procedural strokes were classified by type (ischaemic or haemorrhagic), time of onset (intraprocedural or after the procedure), side (ipsilateral or contralateral), severity (disabling or non-disabling), and patency of the treated artery. Only patients in whom the allocated treatment was initiated were included. The most likely pathophysiological mechanism was determined using the following classification system: (1) carotid-embolic, (2) haemodynamic, (3) thrombosis or occlusion of the revascularised carotid artery, (4) hyperperfusion, (5) cardio-embolic, (6) multiple, and (7) undetermined.

resultsProcedural stroke occurred within 30 days of revascularisation in 85 patients (CAS 58 out of 791 and CEA 27 out of 819). Strokes were predominately ischaemic (77; 56 CAS and 21 CEA), after the procedure (57; 37 CAS and 20 CEA), ipsilateral to the treated artery (77; 52 CAS and 25 CEA), and non-disabling (47; 36 CAS and 11 CEA). Mechanisms of stroke were carotid-embolic (14; 10 CAS and 4 CEA), haemodynamic (20; 15 CAS and 5 CEA), thrombosis or occlusion of the carotid artery (15; 11 CAS and 4 CEA), hyperperfusion (9; 3 CAS and 6 CEA), cardio-embolic (5; 2 CAS and 3 CEA) and multiple causes (3; 3 CAS). In 19 patients (14 CAS and 5 CEA) the cause of stroke remained undetermined.

conclusionAlthough the mechanism of procedural stroke in both CAS and CEA is diverse, haemodynamic disturbance is an important mechanism. Careful attention to blood pressure control could lower the incidence of procedural stroke.

Indexed as

StentsAngioplastyBrain IschemiaCarotid StenosisEndarterectomy, CarotidHemodynamicsHumansIntracranial HemorrhagesRetrospective StudiesRisk FactorsSeverity of Illness IndexStrokeTime FactorsTreatment OutcomeUnited KingdomCarotid artery stentingCarotid endarterectomyCarotid stenosisProcedural strokeStroke mechanism

Identifiers

PMID26160210
PMCPMC4580136
OpenAlexW2137563759

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.