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Γεώργιος Ντάιος Παθολογική Κλινική & Ομώνυμο Ερευνητικό Εργαστήριο

Πόσο σίγουροι είμαστε για το όφελος της ενδαρτηρεκτομής στην ασυμπτωματική καρωτιδική στένωση;. Γεώργιος Ντάιος Παθολογική Κλινική & Ομώνυμο Ερευνητικό Εργαστήριο Ιατρική Σχολή Πανεπιστημίου Θεσσαλίας. Αθήνα 30/11/2013. Disclosures.

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Γεώργιος Ντάιος Παθολογική Κλινική & Ομώνυμο Ερευνητικό Εργαστήριο

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  1. Πόσο σίγουροι είμαστε για το όφελος τηςενδαρτηρεκτομήςστην ασυμπτωματική καρωτιδική στένωση; Γεώργιος Ντάιος Παθολογική Κλινική & Ομώνυμο Ερευνητικό Εργαστήριο Ιατρική Σχολή Πανεπιστημίου Θεσσαλίας Αθήνα 30/11/2013

  2. Disclosures • Support to attend educational activities: Bayer; Sanofi-Aventis; Pfizer; Lundbeck; Boehringer-Ingelheim;Galenica;Elpen; Bristol Myers Squibb. • Honoraria: Quintiles; Medtronic. • Speaker fees: Sanofi • Scholarships: European Stroke Organization; Hellenic Society of Atherosclerosis. • Participation in trials • National coordinator (Greece) for the ENOS trial. • Sub-investigator (AMGEN, 20110118).

  3. JAMA 1995; 273:1421-1428

  4. ACAS: Asymptomatic Carotid Artery Study 5.1% 11% JAMA 1995; 273:1421-1428

  5. Lancet 2004; 363: 1491–502

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

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

  8. Stroke 2011; 42(8):e464-540

  9. 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):e464-540

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

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

  12. Best (???) medical treatment

  13. Lancet 1996; 348: 1329–39

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

  15. Best (???) medical treatment - Better antiplateletsare available now

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

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

  18. Stroke 2008; 39: 3297–3302

  19. Stroke 2008; 39: 3297–3302

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

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

  22. Stroke 2009; 40:e573– e583

  23. International Journal of Stroke 2009; 4:294-299

  24. International Journal of Stroke 2013, e-pub ahead of print

  25. Degree of stenosis Stroke 2000; 31:615-621

  26. Plaque surface Stroke 2000; 31:615-621

  27. Total plaque area Stroke 2011; 42:972-978

  28. Stroke 2006; 37:818-823

  29. Radiology 2009; 252: 502-8

  30. Intraplaquehemorrhage Radiology 2009; 252: 502-8

  31. Microembolicsignals Lancet Neurol 2010; 9: 663–71

  32. Lancet Neurol 2010; 9: 663–71

  33. Microembolicsignals Lancet Neurol 2010; 9: 663–71

  34. Silent strokes J VascSurg 2009;49:902-9

  35. Silent strokes J VascSurg 2009;49:902-9

  36. Degree of stenosis • Plaque surface • Total plaque area • Fibrous cap • Intraplaque hemorrhage • Microemboli • Silent strokes

  37. Take home messages

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