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  1. Perioperative imaging strategies for carotid endarterectomy : an analysis of morbidity and cost-effectiveness in symptomatic patients.

    Article - En anglais

    Objective

    - To assess the cost-effectiveness of four diagnostic strategies for the preoperative evaluation of symptomatic patients who are potential candidates for carotid endarterectomy (ie, 70% to 99% stenosis) : (1) duplex sonography (DS), (2) magnetic resonance angiography (MRA), (3) contrast angiography (CA), and (4) the combination of DS and MRA supplemented by CA for disparate results.

    Methods

    - Cost-effectiveness analysis based largely on published clinical trial data.

    Sensitivities and specificities of noninvasive tests were estimated from 81 patients undergoing prospective evaluation with DS, MRA, and CA.

    Outcome Measure

    - Incremental cost per quality-adjusted year of life gained.

    Results

    - For a hypothetical cohort of symptomatic patients undergoing evaluation for carotid endarterectomy, the combination of tests resulted in the greatest quality-adjusted life expectancy of the four options considered.

    After incorporating the costs of testing, surgery, and stroke, we found that neither the MRA nor the CA strategy was cost-effective.

    Conclusions

    - Our results suggest that for the preoperative detection of a 70% to 99% carotid stenosis, the combination of DS and MRA is associated with the lowest long-term morbidity and mortality and has a favorable cost-effectiveness ratio.

    The combination of tests could potentially replace the current practice of using CA alone in the preoperative evaluation of patients with symptomatic carotid stenosis.

    Mots-clés Pascal : Sténose, Carotide, Endartériectomie, Imagerie médicale, Préopératoire, Diagnostic, Economie santé, Technique, Exploration, Homme, Système nerveux pathologie, Encéphale pathologie, Cérébrovasculaire pathologie, Appareil circulatoire pathologie, Vaisseau sanguin pathologie, Artère pathologie, Système nerveux central pathologie, Chirurgie

    Mots-clés Pascal anglais : Stenosis, Carotid, Endarteriectomy, Medical imagery, Preoperative, Diagnosis, Health economy, Technique, Exploration, Human, Nervous system diseases, Cerebral disorder, Cerebrovascular disease, Cardiovascular disease, Vascular disease, Arterial disease, Central nervous system disease, Surgery

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 95-0551741

    Code Inist : 002B24B04. Création : 01/03/1996.