Evidence map›Paper›PMID 36647921›Full record

SynthesisStroke2023

Safety of Carotid Endarterectomy for Symptomatic Stenosis by Age: Meta-Analysis With Individual Patient Data.

Ya Yuan Rachel Leung, Kasia Bera, Daniel Urriza Rodriguez, Alan Dardik, Jean-Louis Mas, Gioele Simonte, Kittipan Rerkasem, Dominic P J Howard

Open access · hybridAbstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Stroke, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
13citing papers in PubMed, 1 pooled it
4.9field-weighted citation impact, top 4% 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

13 citing papers in PubMed, 1 synthesis or guideline pooled it, 19 citations in OpenAlex.

  1. Pooled it
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  8. Frailty and Cardiovascular Risk.European cardiology · 2026
    Review
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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

8 authors at 6 institutions in 5 countries.

Ya Yuan Rachel LeungWolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, UK (Y.Y.R.L., D.P.J.H.).ORCID 0000-0002-7105-7093
Kasia BeraDepartment of Vascular Surgery, Oxford University Hospitals NHS Trust, UK (K.B., D.U.R., D.P.J.H.).ORCID 0000-0003-3795-6762
Daniel Urriza RodriguezDepartment of Vascular Surgery, Oxford University Hospitals NHS Trust, UK (K.B., D.U.R., D.P.J.H.).
Alan DardikYale Department of Surgery, Departments of Surgery and Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT (A.D.).ORCID 0000-0001-5022-7367
Jean-Louis MasDepartment of Neurology, GHU Paris, Hôpital Sainte-Anne, Université Paris-Cité, Inserm, France (J.-L.M.).ORCID 0000-0003-4891-3127
Gioele SimonteVascular and Endovascular Surgery Unit, Santa Maria della Misericordia, University of Perugia, Italy (G.S.).ORCID 0000-0002-2268-9166
Kittipan RerkasemEnvironmental - Occupational Health Sciences and Non-Communicable Diseases Research Group, Research Institute for Health Sciences, Chiang Mai University, Thailand (K.R.).ORCID 0000-0003-0784-2449
Dominic P J HowardWolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, UK (Y.Y.R.L., D.P.J.H.).ORCID 0000-0001-7564-436X
Oxford University Hospitals NHS Trust · GBUniversity of Oxford · GBChiang Mai University · THInserm · FROspedale Santa Maria · ITYale University · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThere is uncertainty whether elderly patients with symptomatic carotid stenosis have higher rates of adverse events following carotid endarterectomy. In trials, recurrent stroke risk on medical therapy alone increased with age, whereas operative stroke risk was not related. Few octogenarians were included in trials and there has been no systematic analysis of all study types. We aimed to evaluate the safety of carotid endarterectomy in symptomatic elderly patients, particularly in octogenarians.

methodsWe did a systematic review and meta-analysis of studies (from January 1, 1980 through March 1, 2022) reporting post carotid endarterectomy risk of stroke, myocardial infarction, and death in patients with symptomatic carotid stenosis. We included observational studies and interventional arms of randomized trials if the outcome rates (or the raw data to calculate these) were provided. Individual patient data from 4 prospective cohorts enabled multivariate analysis.

resultsOf 47 studies (107 587 patients), risk of perioperative stroke was 2.04% (1.94-2.14) in octogenarians (390 strokes/19 101 patients) and 1.85% (1.75-1.95) in nonoctogenarians (1395/75 537);

conclusionsWe found a modest increase in perioperative risk with age in symptomatic patients undergoing carotid endarterectomy. As stroke risk increases with age when on medical therapy alone, our findings support selective urgent intervention in symptomatic elderly patients.

Indexed as

Carotid StenosisEndarterectomy, CarotidMyocardial InfarctionStrokeAgedAged, 80 and overConstriction, PathologicHumansProspective StudiesRisk FactorsTreatment Outcomeagingcarotid endarterectomycarotid stenosisischemic strokemorbidity

Identifiers

PMID36647921
PMCPMC9855737
OpenAlexW4316810855

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.