Papers by Alison Halliday
Gefässchirurgie, 2013
ABSTRACT Der Asymptomatic Carotid Surgery Trial 2 (ACST-2) ist eine groß und einfach angelegte St... more ABSTRACT Der Asymptomatic Carotid Surgery Trial 2 (ACST-2) ist eine groß und einfach angelegte Studie mit dem Ziel, sowohl die frühen Risiken als auch die langfristige Beständigkeit der Karotisendarteriektomie (CEA) und des Karotisstentings (CAS) an asymptomatischen Patienten mit hochgradiger Karotisstenose zu vergleichen.Patienten kommen für ACST-2 infrage, wenn sie eine schwerwiegende Karotisstenose aufweisen und eine Intervention klar indiziert ist, wobei sowohl die CEA als auch das CAS durchführbar ist, aber beträchtliche Unsicherheit hinsichtlich der besseren Intervention besteht. Teilnehmende Chirurgen und Stenting-Spezialisten können ihre gewohnten Verfahren anwenden. Jegliche CE-gekennzeichneten Geräte sind erlaubt.In ACST-2 sollen bis 2019 mehrere tausend Patienten eingeschlossen werden. Bislang haben die Studienmitarbeiter an 79 Zentren in 25 Ländern über 1200 Patienten randomisiert. Italien ist das Land mit den meisten Rekrutierungen, gefolgt vom Vereinigten Königreich und Schweden. Verblindete Interimanalysen ergaben eine 1%ige Rate ernster Komplikationen in den ersten 30 Tagen nach Eingriff (schwerer Schlaganfall, Myokardinfarkt oder Tod).ACST-2 ist die einzige Studie, die für den verlässlichen Vergleich der kurzfristigen Risiken und langfristigen Vorteile der CEA gegenüber dem CAS bei asymptomatischen Patienten konzipiert wurde. Zudem ergänzt sie andere Karotisstudien, welche den interventionellen Ansatz mit dem medikamentösen Management vergleichen, z. B. Stent-Protected Angioplasty versus Carotid Endarterectomy 2 (SPACE-2). Falls diese Studien bei ausgewählten Patienten einen Nutzen der Karotisintervention zusätzlich zur modernen medikamentösen Behandlung aufzeigen, was wahrscheinlich ist, wird die Frage, ob eine CEA oder ein CAS durchgeführt werden sollte, ihre hohe Relevanz behalten – und nur ACST-2 kann darauf eine Antwort geben.
Circulation, Oct 31, 2007
From Basic Science to Clinical Practice, 2002
... 4 Neurohumoral regulation of vascular tone 70 Kirsty M. McCulloch and John C. McGrath 5 Angio... more ... 4 Neurohumoral regulation of vascular tone 70 Kirsty M. McCulloch and John C. McGrath 5 Angiogenesis: basic concepts and the application of gene therapy 93 ... 10 Nitric oxide 216 NormanChan and Patrick Vallance 11 Magnetic resonance imaging in vascular biology 259 ...
Lancet (London, England), Jan 12, 2016
Age was reported to be an effect-modifier in four randomised controlled trials comparing carotid ... more Age was reported to be an effect-modifier in four randomised controlled trials comparing carotid artery stenting (CAS) and carotid endarterectomy (CEA), with better CEA outcomes than CAS outcomes noted in the more elderly patients. We aimed to describe the association of age with treatment differences in symptomatic patients and provide age-specific estimates of the risk of stroke and death within narrow (5 year) age groups. In this meta-analysis, we analysed individual patient-level data from four randomised controlled trials within the Carotid Stenosis Trialists' Collaboration (CSTC) involving patients with symptomatic carotid stenosis. We included only trials that randomly assigned patients to CAS or CEA and only patients with symptomatic stenosis. We assessed rates of stroke or death in 5-year age groups in the periprocedural period (between randomisation and 120 days) and ipsilateral stroke during long-term follow-up for patients assigned to CAS or CEA. We also assessed dif...
Journal of Neural Transmission, Feb 1, 2011
Patients with a significant carotid stenosis are at an increased risk of suffering from a potenti... more Patients with a significant carotid stenosis are at an increased risk of suffering from a potentially fatal or disabling stroke. The current management strategies available to a patient with an asymptomatic carotid stenosis are either medical therapy alone, or in combination with either carotid endarterectomy, or carotid angioplasty and stenting. Medical therapy alone can reduce the incidence of stroke in general, but whether there is any reduction in stroke attributable to a significant carotid stenosis is less clear. Carotid endarterectomy, on the other hand, has been shown to reduce the incidence of ipsilateral ischaemic stroke in both symptomatic and asymptomatic patients, with the benefits extending into the long-term. Carotid angioplasty and stenting is a newer technique with the benefit of being minimally invasive. The results of trials comparing the technique to endarterectomy have had conflicting results, and the results of large multi-centre trials are awaited. Currently the safest strategy for a patient with a significant asymptomatic carotid stenosis consists of optimal medical therapy with carotid endarterectomy for those less than 75 years of age, who are suitable for surgery.
Journal of Vascular Surgery Official Publication the Society For Vascular Surgery and International Society For Cardiovascular Surgery North American Chapter, Jun 1, 2011
Journal of vascular surgery, 2011
Stroke; a journal of cerebral circulation, 2004
International angiology : a journal of the International Union of Angiology, 1998
The ACST has randomised over 1670 patients to determine if carotid endarterectomy (CEA) prolongs ... more The ACST has randomised over 1670 patients to determine if carotid endarterectomy (CEA) prolongs stroke free survival versus best medical treatment alone. Some patients have had contralateral symptoms to the side under investigation, for which CEA may have been performed. This study aims to determine the prevalence of hemispheric cerebral infarcts in relation to prior contralateral symptoms. Patients with preoperative CT or MR scans were divided into those with prior contralateral stroke, cortical TIA, amaurosis fugax or no symptoms. There were 1144 patients with preoperative CT and 170 patients with MR scans. Incidence of contralateral hemispheric CT and MR infarcts were 19% (222/1144) and 20% (34/170) respectively. Those with prior contralateral stroke (141) had the highest incidence of hemispheric CT infarcts (62%). Those with TIA (129) had a 30% incidence of CT infarct. Incidence of hemispheric CT infarcts were 17% with amaurosis fugax (46) and 10% with no prior symptoms (803). ...
Current Atherosclerosis Reports, 2000
Stroke, 1998
We were surprised to read the rather unequivocal endorsement 1 by the American Heart Association ... more We were surprised to read the rather unequivocal endorsement 1 by the American Heart Association writing group of carotid endarterectomy (CE) for asymptomatic stenosis of greater than 60%. This position does not represent the viewpoint of all stroke neurologists or surgeons, and some professional groups have recently come to the exact opposite conclusion, not recommending CE for asymptomatic stenosis. 2 The writing group states that CE is beneficial if the surgical complication rate is less than 3%. Current evidence indicates that CE complication rates are not being closely monitored at US hospitals. 3 A recent study found that the surgical complication rates were either unknown or not being monitored at over 50% of teaching hospitals in the United States. 4 In the "real world" of CE practice, it is unlikely that a complication rate this low can be uniformly achieved, and a 1991 analysis of Medicare data found that the death rate associated with CE was 2.3%. 5 In addition, we and others have concerns that the Asymptomatic Carotid Atherosclerosis Study (ACAS) results cannot be generalized. 6 -9 Only 4% of the eligible patients were entered into the study. 10 In addition, 29% of the surgeons who applied for participation in the trial were either rejected or did not complete the credentialing process. 11 Thus, in the ideal setting for producing a positive surgical result (namely, combining low-surgicalrisk patients with surgeons vetted for their excellence), a statistically significant result was obtained, which may not be clinically meaningful to all clinicians.
Journal of Stroke and Cerebrovascular Diseases, 1997
Journal of Neural Transmission, 2011
Patients with a significant carotid stenosis are at an increased risk of suffering from a potenti... more Patients with a significant carotid stenosis are at an increased risk of suffering from a potentially fatal or disabling stroke. The current management strategies available to a patient with an asymptomatic carotid stenosis are either medical therapy alone, or in combination with either carotid endarterectomy, or carotid angioplasty and stenting. Medical therapy alone can reduce the incidence of stroke in general, but whether there is any reduction in stroke attributable to a significant carotid stenosis is less clear. Carotid endarterectomy, on the other hand, has been shown to reduce the incidence of ipsilateral ischaemic stroke in both symptomatic and asymptomatic patients, with the benefits extending into the long-term. Carotid angioplasty and stenting is a newer technique with the benefit of being minimally invasive. The results of trials comparing the technique to endarterectomy have had conflicting results, and the results of large multi-centre trials are awaited. Currently the safest strategy for a patient with a significant asymptomatic carotid stenosis consists of optimal medical therapy with carotid endarterectomy for those less than 75 years of age, who are suitable for surgery.
European Journal of Vascular and Endovascular Surgery, 1996
Cerebrovascular Diseases, 1998
Background: Several clinical trials regarding carotid endarterectomy for asymptomatic stenosis ha... more Background: Several clinical trials regarding carotid endarterectomy for asymptomatic stenosis have been conducted in the past two decades. These research studies have not resolved the controversy regarding the optimal treatment of patients with this condition. Summary of review: We examine some of the reasons why there is persisting uncertainty regarding the value of carotid endarterectomy for asymptomatic stenosis. These include the sample size of earlier studies, the generalizability of these studies, and the clinical importance of the reported surgical benefits in some studies. We then review the rationale for another, larger clinical trial. Conclusions: The role of endarterectomy for asymptomatic stenosis remains an unsettled issue. A larger clinical trial may shed light on how to best identify which patients derive clinically significant benefits from prophylactic carotid artery surgery. OOOOOOOOOOOOOOOOOOOOOO
British Journal of Surgery, 1999
Background: Carotid endarterectomy (CEA) has been an evidence-based treatment for symptomatic sev... more Background: Carotid endarterectomy (CEA) has been an evidence-based treatment for symptomatic severe carotid stenosis since 1991. Surgical techniques and patient selection have changed over the years. The results of CEA in a single centre over a 23-year period were reviewed. Methods: Prospectively gathered preoperative, operative, postoperative and long-term follow-up data were analysed. Routine intraoperative shunting and patch closure has been used since 1988. Data were analysed using the v 2 test or by logistic regression, adjusting for age at operation and date of operation. Results: Five hundred and seventy-three CEAs (37 bilateral and three repeat procedures) were carried out on 533 patients. Trainees performed an increasing proportion of CEAs from 1996 to 1998 (15, 50 and 56 per cent respectively). The perioperative death rate was 0á8 per cent and the rate of any perioperative neurological de®cit was 6á9 per cent. Other causes of morbidity included nerve injury (5á1 per cent) of which the commonest was to the hypoglossal nerve (2á7 per cent). During follow-up (median 4 (range 0±22) years) there were 81 neurological events (15á9 per cent) which included 35 ipsilateral (6á6 per cent) and 18 contralateral (3á4 per cent) strokes. There was no signi®cant difference in outcome for grade of surgeon, intraoperative shunting or patch closure. Major causes of death were cardiac death (74; 14á6 per cent) followed by stroke (23; 4á5 per cent) and cancer (20; 3á9 per cent). Conclusion: The introduction of routine intraoperative shunting and patch closure, as well as allowing surgical trainees to perform supervised CEAs, has not affected perioperative morbidity and mortality rates or long-term outcome.
British Journal of Surgery, 2009
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Papers by Alison Halliday