Γεώργιος Ντάιος Παθολογική Κλινική & Ομώνυμο...

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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. - PowerPoint PPT Presentation

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30/11/20131DisclosuresSupport 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 trialsNational coordinator (Greece) for the ENOS trial.Sub-investigator (AMGEN, 20110118).

, . 20 . . ACAS ACST 1995 2004 .3

JAMA 1995; 273:1421-1428 ACAS, 1987 1993 ( 20 ) 1600 >70% 5 .4

ACAS: Asymptomatic Carotid Artery StudyJAMA 1995; 273:1421-14285.1%11% 5.1% 11% .5

Lancet 2004; 363: 1491502 , ACST, 1993 2003, 3000 >70% 5 . 6

ACST: Asymptomatic Carotid Surgery TrialLancet 2004; 363: 1491502 6.5% 12% .7

ACST: Asymptomatic Carotid Surgery TrialLancet 2004; 363: 1491502 , , 8

Stroke 2011; 42(8):e464-540 , , American Stroke Association .9It 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 >70% . 10

, .11

ACST: Asymptomatic Carotid Surgery TrialLancet 2004; 363: 1491502, ACST , 2.5%. 12

Number-Needed-to-Treat: 40 (to prevent 1 stroke in 5 years) number needed to treat , 40 5 . , , . 13Best (???) medical treatment , 1983 2003, . ...14

. , .15

Lancet 1996; 348: 132939 . 1996 CAPRIE .

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CAPRIE: Clopidogrel vs. AspirinLancet 1996; 348: 132939 , .17Best (???) medical treatment- Better antiplatelets are available now, ACAS ACST, , .18ACST: Asymptomatic Carotid Surgery Trial

Lancet 2004; 363: 1491502 . ACST . 1993-1996, 10-15% , 97-99 2000-2003 , 30% 60% , .19ACST: Asymptomatic Carotid Surgery Trial

Lancet 2004; 363: 1491502 , . . 70% , 30%, , . .20

Stroke 2008; 39: 32973302 , SPARCL JUPITER, . SPARCL 21

Stroke 2008; 39: 32973302 Placebo, .22Best (???) medical treatment- Better antiplatelets are available now- 30% did not receive statin, , . 23

. ACAS 0.14%, . 1.1%. real-life , 8 ACAS, ACAS . ;Excellent safety record

an annual minimum of 12 carotid endarterectomies

mortality/morbidity rate