المؤلفون: Heggie, Robert, Wu, Olivia, White, Phil, Ford, Gary A, Wardlaw, Joanna, Brown, Martin M, Clifton, Andrew, Muir, Keith W

المصدر: International Journal of Stroke; Oct2020, Vol. 15 Issue 8, p881-898, 18p

مصطلحات موضوعية: STROKE patients, THROMBECTOMY, TREATMENT effectiveness

مصطلحات جغرافية: UNITED Kingdom

مستخلص: Background: Recent clinical trials have demonstrated the efficacy of mechanical thrombectomy in acute ischemic stroke. Aims: To determine the cost-effectiveness, value of future research, and value of implementation of mechanical thrombectomy. Methods: Using UK clinical and cost data from the Pragmatic Ischemic Stroke Thrombectomy Evaluation (PISTE) trial, we estimated the cost-effectiveness of mechanical thrombectomy over time horizons of 90-days and lifetime, based on a decision-analytic model, using all existing evidence. We performed a meta-analysis of seven clinical trials to estimate treatment effects. We used sensitivity analysis to address uncertainty. Value of implementation analysis was used to estimate the potential value of additional implementation activities to support routine delivery of mechanical thrombectomy. Results: Over the trial period (90 days), compared with best medical care alone, mechanical thrombectomy incurred an incremental cost of £5207 and 0.025 gain in QALY (incremental cost-effectiveness ratio (ICER) £205,279), which would not be considered cost-effective. However, mechanical thrombectomy was shown to be cost-effective over a lifetime horizon, with an ICER of £3466 per QALY gained. The expected value of perfect information per patient eligible for mechanical thrombectomy in the UK is estimated at £3178. The expected value of full implementation of mechanical thrombectomy is estimated at £1.3 billion over five years. Conclusion: Mechanical thrombectomy was cost-effective compared with best medical care alone over a patient's lifetime. On the assumption of 30% implementation being achieved throughout the UK healthcare system, we estimate that the population health benefits obtained from this treatment are greater than the cost of implementation. Trial registration: NCT01745692. [ABSTRACT FROM AUTHOR]

: Copyright of International Journal of Stroke is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Stansby, Gerard, Macdonald, Sumaira, Allison, Robert, de Belder, Mark, Brown, Martin M., Dark, John, Featherstone, Roland, Flather, Marcus, Ford, Gary A., Halliday, Alison, Malik, Iqbal, Naylor, Ross, Pepper, John, Rothwell, Peter M.

المصدر: Angiology; Aug2011, Vol. 62 Issue 6, p457-460, 4p

مصطلحات موضوعية: CAROTID artery stenosis, CAROTID artery diseases, CAROTID artery surgery, CORONARY artery bypass, ENDARTERECTOMY, SURGICAL stents, THERAPEUTICS

مصطلحات جغرافية: UNITED Kingdom

مستخلص: The Carotid Disease and Cardiac Surgery Consensus Meeting was convened as a multidisciplinary gathering to consider the management of patients undergoing cardiac surgery who are found to have asymptomatic carotid artery disease. There are no randomized trials concerning whether carotid interventions are of value in this situation and the natural history is unclear. Bilateral carotid artery disease (≥70% stenosis) should be regarded clinically relevant when considering hemodynamic and short-term surgical stroke risk. However, this may be because the presence of significant carotid disease is also a marker for aortic arch and intracerebral disease. A natural history study is urgently needed to determine the incidence, predictive factors, and natural history of asymptomatic carotid disease in patients undergoing contemporary cardiac surgical interventions to inform the design of any future randomized trial. [ABSTRACT FROM PUBLISHER]

: Copyright of Angiology is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Brown, Martin M., Humphrey, Peter R.D.

المصدر: BMJ: British Medical Journal (International Edition). 10/31/92, Vol. 305 Issue 6861, p1071. 4p. 3 Black and White Photographs, 2 Charts.

مصطلحات موضوعية: *CAROTID artery surgery, *ARTERIAL stenosis, *MEDICAL care, *DISEASE risk factors

مصطلحات جغرافية: UNITED Kingdom

مستخلص: Analyzes the carotid endarterectomy for management of transient ischaemic attack and ischaemic stroke in Great Britain. Symptoms of carotid stenosis; Introduction of carotid artery surgery in 1950s; Risk factors of carotid stenosis; Effectiveness of carotid endarterectomy; Implications of carotid endarterectomy for health care services.

المؤلفون: Bath, Philip M., Prasad, Abhiram, Brown, Martin M., MacGregor, Graham A.

المصدر: BMJ: British Medical Journal (International Edition); 10/23/93, Vol. 307 Issue 6911, p1045, 1p, 1 Chart

مصطلحات موضوعية: ANTICOAGULANTS, ATRIAL fibrillation, PATIENTS

مصطلحات جغرافية: UNITED Kingdom

مستخلص: Investigates the effectiveness of anticoagulation in patients with atrial fibrillation in Great Britain. Reduction of risk of ischemic strokes and death in patients; Causes of atrial fibrillation; Risks of the anticoagulation.

المؤلفون: Ederle, Jörg¹, Davagnanam, Indran², van der Worp, H Bart³, Venables, Graham S⁴, Lyrer, Philippe A⁵, Featherstone, Roland L¹, Brown, Martin M¹ martin.brown@ucl.ac.uk, Jäger, H Rolf^1,2

المصدر: Lancet Neurology. Sep2013, Vol. 12 Issue 9, p866-872. 7p.

مصطلحات موضوعية: *ACADEMIC medical centers, *CEREBRAL revascularization, *COMPARATIVE studies, *DEMYELINATION, *MEDICAL cooperation, *HEALTH outcome assessment, *RESEARCH, *SURGICAL stents, *STROKE, *SURGICAL complications, *RANDOMIZED controlled trials, *TREATMENT effectiveness, *BLIND experiment, *CAROTID endarterectomy, *DISEASE complications, *DIAGNOSIS, CAROTID artery stenosis

مصطلحات جغرافية: UNITED Kingdom

مستخلص: Summary: Background: Findings from randomised trials have shown a higher early risk of stroke after carotid artery stenting than after carotid endarterectomy. We assessed whether white-matter lesions affect the perioperative risk of stroke in patients treated with carotid artery stenting versus carotid endarterectomy. Methods: Patients with symptomatic carotid artery stenosis included in the International Carotid Stenting Study (ICSS) were randomly allocated to receive carotid artery stenting or carotid endarterectomy. Copies of baseline brain imaging were analysed by two investigators, who were masked to treatment, for the severity of white-matter lesions using the age-related white-matter changes (ARWMC) score. Randomisation was done with a computer-generated sequence (1:1). Patients were divided into two groups using the median ARWMC. We analysed the risk of stroke within 30 days of revascularisation using a per-protocol analysis. ICSS is registered with controlled-trials.com, number ISRCTN 25337470. Findings: 1036 patients (536 randomly allocated to carotid artery stenting, 500 to carotid endarterectomy) had baseline imaging available. Median ARWMC score was 7, and patients were dichotomised into those with a score of 7 or more and those with a score of less than 7. In patients treated with carotid artery stenting, those with an ARWMC score of 7 or more had an increased risk of stroke compared with those with a score of less than 7 (HR for any stroke 2·76, 95% CI 1·17–6·51; p=0·021; HR for non-disabling stroke 3·00, 1·10–8·36; p=0·031), but we did not see a similar association in patients treated with carotid endarterectomy (HR for any stroke 1·18, 0·40–3·55; p=0·76; HR for disabling or fatal stroke 1·41, 0·38–5·26; p=0·607). Carotid artery stenting was associated with a higher risk of stroke compared with carotid endarterectomy in patients with an ARWMC score of 7 or more (HR for any stroke 2·98, 1·29–6·93; p=0·011; HR for non-disabling stroke 6·34, 1·45–27·71; p=0·014), but there was no risk difference in patients with an ARWMC score of less than 7. Interpretation: The presence of white-matter lesions on brain imaging should be taken into account when selecting patients for carotid revascularisation. Carotid artery stenting should be avoided in patients with more extensive white-matter lesions, but might be an acceptable alternative to carotid endarterectomy in patients with less extensive lesions. Funding: Medical Research Council, the Stroke Association, Sanofi-Synthélabo, the European Union Research Framework Programme 5. [Copyright &y& Elsevier]

المؤلفون: Hostettler, Isabel C.^1,2 (AUTHOR), Bernal-Quiros, Manuel² (AUTHOR), Wong, Andrew³ (AUTHOR), Sharma, Nikhil^4,5 (AUTHOR), Wilson, Duncan¹ (AUTHOR), Seiffge, David J.^1,6,7 (AUTHOR), Shakeshaft, Clare¹ (AUTHOR), Jäger, Hans R.⁸ (AUTHOR), Cohen, Hannah⁹ (AUTHOR), Yousry, Tarek⁸ (AUTHOR), Al-Shahi Salman, Rustam¹⁰ (AUTHOR), Lip, Gregory Y.H.^11,12 (AUTHOR), Brown, Martin M.¹ (AUTHOR), Muir, Keith W.¹³ (AUTHOR), Werring, David J.¹ (AUTHOR), Houlden, Henry^1,2 (AUTHOR) h.houlden@ucl.ac.uk

المصدر: Neurobiology of Aging. Dec2019, Vol. 84, p237.e1-237.e3. 1p.

مصطلحات موضوعية: *FRONTOTEMPORAL lobar degeneration, *COGNITION disorders, *FRONTOTEMPORAL dementia, *AMYOTROPHIC lateral sclerosis, *HEMORRHAGE, *DEMENTIA

مصطلحات جغرافية: UNITED Kingdom

مستخلص: The chromosome 9 open reading frame 72 (C9orf72) GGGGCC repeat expansion has been associated with several diseases, including amyotrophic lateral sclerosis (ALS) and frontotemporal dementia. It has also been associated with increased white matter changes in frontotemporal dementia and risk of cognitive impairment in ALS. Dementia is common both before and after intracerebral hemorrhage (ICH). Because the mechanisms of cognitive impairment in patients with ICH are uncertain, we investigated whether C9orf72 could influence dementia risk in this patient group. Therefore, we genotyped 1010 clinically characterized ICH cases and 2147 population controls in comparison with prior data of dementia and ALS cases. We did not find any association between C9orf72 repeat expansion and repeat size with ICH compared with controls or with dementia when assessing ICH patients only. The frequency of C9orf72 expansions in our series of individuals born in 1946 (2/2147) and other U.K. controls was age dependent, decreasing with increasing age, highlighting the high age-dependent penetrance of this expansion. [ABSTRACT FROM AUTHOR]