Risk, Causes and Prevention of Ischemic Stroke in Elderly Patients with Symptomatic Internal Carotid Artery Stenosis
Bibliographic record
Abstract
91 Background. Atherosclerosis is an important cause of stroke in the elderly. Carotid endarterectomy (CE) benefits patients with 70–99% symptomatic internal carotid artery (ICA) stenosis, less for patients with 50–69% stenosis. The benefit of CE in elderly patients (≥75 years) requires evaluation. Methods. Elderly patients with symptomatic ICA stenosis were compared to those 65–74 years and <65 years in regards to baseline characteristics, risk of ipsilateral ischemic stroke at 2 years by degree of stenosis and treatment group and risk of ischemic stroke in the territory of an asymptomatic contralateral carotid artery. Results. The risk of ipsilateral ischemic stroke was highest in the medically-treated elderly regardless of the degree of stenosis. Among 659 patients with 70–99% stenosis, the absolute risk reduction (ARR) of ipsilateral ischemic stroke by CE was 28.9% for patients ≥75 years (N=71), 15.1% for 65–74 years (N=285) and 9.7% for <65 years (N=303). Among patients with 50–69% stenosis, the ARR was significant only in those ≥75 years (N=145) with an ARR of 17.3%. The perioperative risk of stroke and death at any degree of stenosis was less in the elderly: 5.1% for patients ≥75 years, 5.4% for 65–74 years and 7.8% for <65 years. The numbers of patients ≥75 years with 70–99% and 50–69% stenosis needed to treat (NNT) by CE to prevent one ipsilateral stroke within 2 years were 3 and 6, respectively. For 60–99% asymptomatic contralateral ICA stenosis, the 2 year risk of stroke was 7.8% in patients ≥75 years and 7.4% in those < 75 years. The risk of ischemic stroke at 5 years in the territory of a 60–99% asymptomatic ICA stenosis was higher in patients ≥75 years (24.8%) than in patients <75 years (14.9%). Conclusions. In the prevention of ipsilateral ischemic stroke, elderly patients with 50–99% symptomatic carotid stenosis benefited more from CE than younger patients. To achieve this benefit, patients must be carefully selected, excluding those with other life threatening illnesses.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".