High risk plaque, high risk patient or high risk procedure?

Naylor, A.R., and Golledge, J. (2006) High risk plaque, high risk patient or high risk procedure? European Journal of Vascular and Endovascular Surgery, 32 (5). pp. 557-560.

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SAPPHIRE, a randomised trial of endarterectomy versus angioplasty in ’high-risk’ patients, concluded that angioplasty was ’not inferior’ to surgery. This has subsequently been translated to mean that angioplasty was ’preferable’ or ’advisable’ in patients considered high-risk for surgery, with no further discrimination between symptomatic and asymptomatic individuals. Moreover, there have been suggestions that the accepted procedural risks may have to be increased in these patients. In fact, 71% of patients in SAPPHIRE were asymptomatic in whom there was an average 6% 30-day death/stroke rate. At this level of risk, neither surgery nor angioplasty could ever prevent long-term stroke. The concept of identifying high-risk patients is laudable, but they should be high risk for stroke (i.e. symptomatic). There is currently little systematic evidence to include asymptomatic patients within this definition.

Item ID: 4231
Item Type: Article (Research - C1)
ISSN: 1532-2165
Keywords: carotid stenosis; stroke; endarterectomy; angioplasty
Date Deposited: 23 Sep 2009 06:54
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1102 Cardiovascular Medicine and Haematology > 110201 Cardiology (incl Cardiovascular Diseases) @ 100%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920103 Cardiovascular System and Diseases @ 100%
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