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Πόσο σίγουροι είμαστε για το όφελος της ενδαρτηρεκτομής; Γεώργιος Ντάιος Παθολογική Κλινική & Ομώνυμο Ερευνητικό Εργαστήριο Ιατρική Σχολή Πανεπιστημίου.

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Presentation on theme: "Πόσο σίγουροι είμαστε για το όφελος της ενδαρτηρεκτομής; Γεώργιος Ντάιος Παθολογική Κλινική & Ομώνυμο Ερευνητικό Εργαστήριο Ιατρική Σχολή Πανεπιστημίου."— Presentation transcript:

1 Πόσο σίγουροι είμαστε για το όφελος της ενδαρτηρεκτομής; Γεώργιος Ντάιος Παθολογική Κλινική & Ομώνυμο Ερευνητικό Εργαστήριο Ιατρική Σχολή Πανεπιστημίου Θεσσαλίας Heart Vessels Stroke Αthens,

2 Disclosures Support to attend conferences: Bayer; Sanofi-Aventis; Pfizer; Lundbeck; Boehringer-Ingelheim; Bristol Myers Squibb; Galenica. Honoraria: Quintiles; CHUV. Scholarships: European Stroke Organization; Hellenic Society of Atherosclerosis. National coordinator (Greece) for the ENOS trial.

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4 JAMA 1995; 273:

5 ACAS: Asymptomatic Carotid Artery Study JAMA 1995; 273: % 11%

6 Lancet 2004; 363: 1491–502

7 ACST: Asymptomatic Carotid Surgery Trial Lancet 2004; 363: 1491–502

8 ACST: Asymptomatic Carotid Surgery Trial Lancet 2004; 363: 1491–502

9 Stroke 2011; 42(8):e

10 It is reasonable to perform carotid endarterectomy in asymptomatic patients with >70% internal carotid artery stenosis if the risk of perioperative stroke, MI, and death is low. (Level A, Class IIb) Stroke 2011; 42(8):e

11 ACST: Asymptomatic Carotid Surgery Trial Lancet 2004; 363: 1491–502

12 Number-Needed-to-Treat: 40 (to prevent 1 stroke in 5 years)

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14 Best (???) medical treatment

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16 Lancet 1996; 348: 1329–39

17 CAPRIE: Clopidogrel vs. Aspirin Lancet 1996; 348: 1329–39

18 Lancet 2006; 367: 1665–73

19 ESPRIT: Aggrenox vs. Aspirin Lancet 2006; 367: 1665–73

20 Best (???) medical treatment - Better antiplatelets are available now

21 ACST: Asymptomatic Carotid Surgery Trial Lancet 2004; 363: 1491–502

22 ACST: Asymptomatic Carotid Surgery Trial Lancet 2004; 363: 1491–502

23 Stroke 2008; 39: 3297–3302

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25 Best (???) medical treatment - Better antiplatelets are available now - 30% did not receive statin

26 Stroke 2009; 40:e573– e583

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28 Excellent safety record  an annual minimum of 12 carotid endarterectomies  mortality/morbidity rate <3% in the last 50 cases.  40% of initial applicants were rejected  2 strokes/deaths  temporarily suspended ACAS: Asymptomatic Carotid Artery Study

29 Subgroup analysis ?

30 ACST: Asymptomatic Carotid Surgery Trial Lancet 2004; 363: 1491–502

31 Stroke 2004; 35:

32 Lancet 2005; 365:176-86

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36 Subgroup analysis

37 Risk stratification ?

38 Degree of stenosis Stroke 2000; 31:

39 Plaque surface

40 Stroke 2011; 42: Total plaque area

41 Stroke 2006; 37:

42 Radiology 2009; 252: 502-8

43 Intraplaque hemorrhage Radiology 2009; 252: 502-8

44 Lancet Neurol 2010; 9: 663–71 Microembolic signals

45 Lancet Neurol 2010; 9: 663–71

46 Microembolic signals Lancet Neurol 2010; 9: 663–71

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48 Silent strokes J Vasc Surg 2009;49:902-9

49 Silent strokes J Vasc Surg 2009;49:902-9

50 Risk stratification -Degree of stenosis -Plaque surface -Total plaque area -Fibrous cap -Intraplaque hemorrhage -Microemboli -Silent strokes

51 Take home messages


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