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

Abstract

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.

• Authors: A R Naylor, J Golledge
• Journal: European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery (Eur J Vasc Endovasc Surg) Vol. 32 Issue 5 Pg. 557-60 (Nov 2006) ISSN: 1078-5884 [Print] England
• PMID: 16870479 (Publication Type: Journal Article)

Topics

• Angioplasty (adverse effects)
• Carotid Artery Diseases (mortality, surgery)
• Endarterectomy, Carotid (adverse effects)
• Humans
• Patient Selection
• Randomized Controlled Trials as Topic
• Research Design
• Risk Assessment
• Stents
• Stroke (etiology)