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- Ederle, Joerg, et al.
(författare)
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Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial
- 2010
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Ingår i: The Lancet. - 1474-547X. ; 375:9719, s. 985-997
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Tidskriftsartikel (refereegranskat)abstract
- Background Stents are an alternative treatment to carotid endarterectomy for symptomatic carotid stenosis, but previous trials have not established equivalent safety and efficacy. We compared the safety of carotid artery stenting with that of carotid endarterectomy. Methods The International Carotid Stenting Study (ICSS) is a multicentre, international, randomised controlled trial with blinded adjudication of outcomes. Patients with recently symptomatic carotid artery stenosis were randomly assigned in a 1:1 ratio to receive carotid artery stenting or carotid endarterectomy. Randomisation was by telephone call or fax to a central computerised service and was stratified by centre with minimisation for sex, age, contralateral occlusion, and side of the randomised artery. Patients and investigators were not masked to treatment assignment. Patients were followed up by independent clinicians not directly involved in delivering the randomised treatment. The primary outcome measure of the trial is the 3-year rate of fatal or disabling stroke in any territory, which has not been analysed yet. The main outcome measure for the interim safety analysis was the 120-day rate of stroke, death, or procedural myocardial infarction. Analysis was by intention to treat (ITT). This study is registered, number ISRCTN25337470. Findings The trial enrolled 1713 patients (stenting group, n=855; endarterectomy group, n=858). Two patients in the stenting group and one in the endarterectomy group withdrew immediately after randomisation, and were not included in the ITT analysis. Between randomisation and 120 days, there were 34 (Kaplan-Meier estimate 4.0%) events of disabling stroke or death in the stenting group compared with 27 (3.2%) events in the endarterectomy group (hazard ratio [HR] 1.28, 95% CI 0.77-2.11). The incidence of stroke, death, or procedural myocardial infarction was 8.5% in the stenting group compared with 5.2% in the endarterectomy group (72 vs 44 events; HR 1.69, 1.16-2.45, p=0.006), Risks of any stroke (65 vs 35 events; HR 1.92, 1.27-2.89) and all-cause death (19 vs seven events; HR 2.76, 1.16-6.56) were higher in the stenting group than in the endarterectomy group. Three procedural myocardial infarctions were recorded in the stenting group, all of which were fatal, compared with four, all non-fatal, in the endarterectomy group. There was one event of cranial nerve palsy in the stenting group compared with 45 in the endarterectomy group. There were also fewer haematomas of any severity in the stenting group than in the endarterectomy group (31 vs 50 events; p=0.0197). Interpretation Completion of long-term follow-up is needed to establish the efficacy of carotid artery stenting compared with endarterectomy. In the meantime, carotid endarterectomy should remain the treatment of choice for patients suitable for surgery.
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| 2. |
- Grinham, Alistair, et al.
(författare)
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The importance of small artificial water bodies as sources of methane emissions in Queensland, Australia
- 2018
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Ingår i: Hydrology and Earth System Sciences. - : COPERNICUS GESELLSCHAFT MBH. - 1027-5606 .- 1607-7938. ; 22:10, s. 5281-5298
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Tidskriftsartikel (refereegranskat)abstract
- Emissions from flooded land represent a direct source of anthropogenic greenhouse gas (GHG) emissions. Methane emissions from large, artificial water bodies have previously been considered, with numerous studies assessing emission rates and relatively simple procedures available to determine their surface area and generate upscaled emissions estimates. In contrast, the role of small artificial water bodies (ponds) is very poorly quantified, and estimation of emissions is constrained both by a lack of data on their spatial extent and a scarcity of direct flux measurements. In this study, we quantified the total surface area of water bodies amp;lt; 10(5) m(2) across Queensland, Australia, and emission rates from a variety of water body types and size classes. We found that the omission of small ponds from current official land use data has led to an underestimate of total flooded land area by 24 %, of small artificial water body surface area by 57% and of the total number of artificial water bodies by 1 order of magnitude. All studied ponds were significant hotspots of methane production, dominated by ebullition (bubble) emissions. Two scaling approaches were developed with one based on pond primary use (stock watering, irrigation and urban lakes) and the other using size class. Both approaches indicated that ponds in Queensland alone emit over 1.6 Mt CO2 eq.yr(-1), equivalent to 10% of the states entire land use, land use change and forestry sector emissions. With limited data from other regions suggesting similarly large numbers of ponds, high emissions per unit area and under-reporting of spatial extent, we conclude that small artificial water bodies may be a globally important missing source of anthropogenic greenhouse gas emissions.
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