Abstract Details

Title The BRIDGE Project (BRIDGing the Gap in StrokE Management): Trans-Atlantic Differences in Management of Carotid Stenosis

Topic Interventional Neurology

Presentation(s) P07 - (-)

Poster/Presentation
Number 250

Objective

Background BACKGROUND: Optimum management of symptomatic (sx) and asymptomatic (asx)carotid stenosis remains controversial despite clinical trials evaluating Carotid Endarterectomy (CEA) and Carotid Stenting (CAS).

Design/Methods DESIGN/METHODS: A 3-round, Delphi survey was sent to members of the European Stroke Organisation(n=390) and select NA stroke neurologists at the University of Texas at Houston Stroke Program (n=289). Those completing the survey were shown all responses broken down by EU/NA after each of the first 2 rounds. Continent specific consensus was defined to be > 80% agreement.

Results RESULTS: 100 (15%, of which 73% EU) completed all 3-Delphi rounds, 19% of all EU vs 9% NA ([chi]2=11.62, p=0.0007): 76% male; 69% treating between 1-8 new cases of carotid stenosis per month. In the final round, EU reached consensus in 7/11 statements, while NA did in 4/11. Ninety-percent of EU vs 70% of NA ([chi]2=8.09, p=0.017) disagreed that CAS and CEA are equivalent treatments for sx carotid stenosis, and stated that CEA is superior.There remains a significant difference between EU and NA when considering ipsilateral stroke and death < 30 days as primary outcome ([chi]2=12.18, p=0.007). Sixty-nine-percent of NA agreed that there is a stronger indication for CAS over CEA in patients < 65 years for sx carotid stenosis whereas 55% of EU ([chi]2=11.39, p=0.023) disagreed with the statement. 81% of EU and 80% of NA said they would 'sometimes' recommend CEA for an asx carotid stenosis . When asked how likely they would recommend CAS for an asx carotid stenosis, 62% of NA said 'sometimes' vs 60% of EU said 'never'([chi]2=3.54, p=0.06).

Conclusions CONCLUSIONS: EU has a stronger belief in the superiority of CEA, while for NA, the methods are seen as almost equivalent. Areas of lack of consensus may provide direction for future clinical trials.

Authors/Disclosures
Clotilde Balucani, MD, PhD PRESENTER	Dr. Balucani has nothing to disclose.
Vanessa Arnedo, MPH	No disclosure on file
Didier Leys, MD, FAAN	The institution of Dr. Leys has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Wiley. Dr. Leys has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Wiley.
	No disclosure on file
Richard M. Ransohoff, MD (Third Rock Ventures)	Dr. Ransohoff has received personal compensation for serving as an employee of Third Rock Ventures. Dr. Ransohoff has stock in Biogen. Dr. Ransohoff has received intellectual property interests from a discovery or technology relating to health care.
	No disclosure on file
James C. Grotta, MD, FAAN (Memorial Hermann Hospital Life Flight)	Dr. Grotta has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Frazer Ltd. Dr. Grotta has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Haemonetics. Dr. Grotta has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Acticor. Dr. Grotta has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Prolong Pharma. Dr. Grotta has received publishing royalties from a publication relating to health care. Dr. Grotta has received publishing royalties from a publication relating to health care.
Nicole Gonzales, MD (University of Colorado Anschutz Medical Campus)	The institution of Dr. Gonzales has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology.
Sean I. Savitz, MD	Dr. Savitz has nothing to disclose.
Thomas G. Brott, MD, FAAN (Mayo Clinic)	Dr. Brott has nothing to disclose.
Werner Hacke, MD (University of Heidelberg)	No disclosure on file
Steven Levine, MD, FAHA (SUNY Downstate Medical Center)	Dr. Levine has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for MEDLINK. Dr. Levine has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for Law Firms. The institution of Dr. Levine has received research support from NIH.

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