{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T06:29:28Z","timestamp":1787639368715,"version":"build-2736575974"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2021,1,14]],"date-time":"2021-01-14T00:00:00Z","timestamp":1610582400000},"content-version":"vor","delay-in-days":644,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2019,4,11]],"date-time":"2019-04-11T00:00:00Z","timestamp":1554940800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2019,4,11]],"date-time":"2019-04-11T00:00:00Z","timestamp":1554940800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2019,4,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Guidelines recommend treating patients with an internal carotid artery near occlusion (ICANO) with best medical therapy (BMT) based on weak evidence. Consequently, patients with ICANO were excluded from randomized trials. The aim of this individual-patient data (IPD) meta-analysis was to determine the optimal treatment approach.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A systematic search was performed in MEDLINE, EMBASE and the Cochrane Library databases in January 2018. The primary outcome was the occurrence of any stroke or death within the first 30 days of treatment, analysed by multivariable mixed-effect logistic regression. The secondary outcome was the occurrence of any stroke or death beyond 30 days up to 1 year after treatment, evaluated by Kaplan\u2013Meier survival analysis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The search yielded 1526 articles, of which 61 were retrieved for full-text review. Some 32 studies met the inclusion criteria and pooled IPD were available from 11 studies, including some 703 patients with ICANO. Within 30 days, any stroke or death was reported in six patients (1\u00b78 per cent) in the carotid endarterectomy (CEA) group, five (2\u00b72 per cent) in the carotid artery stenting (CAS) group and seven (4\u00b79 per cent) in the BMT group. This resulted in a higher 30-day stroke or death rate after BMT than after CEA (odds ratio 5\u00b763, 95 per cent c.i. 1\u00b730 to 24\u00b745; P = 0\u00b7021). No differences were found between CEA and CAS. The 1-year any stroke- or death-free survival rate was 96\u00b71 per cent for CEA, 94\u00b74 per cent for CAS and 81\u00b72 per cent for BMT.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>These data suggest that BMT alone is not superior to CEA or CAS with respect to 30-day or 1-year stroke or death prevention in patients with ICANO. These patients do not appear to constitute a high-risk group for surgery, and consideration should made to including them in future RCTs of internal carotid artery interventions.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1002\/bjs.11159","type":"journal-article","created":{"date-parts":[[2019,4,12]],"date-time":"2019-04-12T04:23:58Z","timestamp":1555043038000},"page":"665-671","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":40,"title":["Meta-analysis of the outcomes of treatment of internal carotid artery near occlusion"],"prefix":"10.1093","volume":"106","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7085-2474","authenticated-orcid":false,"given":"A J A","family":"Meershoek","sequence":"first","affiliation":[{"name":"Departments of Vascular Surgery"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E E","family":"Vries","sequence":"additional","affiliation":[{"name":"Departments of Vascular Surgery"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D","family":"Veen","sequence":"additional","affiliation":[{"name":"Department of Methodology and Statistics, Utrecht University, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H M","family":"Ruijter","sequence":"additional","affiliation":[{"name":"Experimental Cardiology Laboratory, University Medical Centre Utrecht, Utrecht"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G J","family":"Borst","sequence":"additional","affiliation":[{"name":"Departments of Vascular Surgery"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Garcia-Pastor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Gonzalez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E","family":"Johansson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Y","family":"Matsuda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T","family":"Ogata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F","family":"Oka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R","family":"Pulli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Sakamoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Tanaskovic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D","family":"Radak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Son","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,4,11]]},"reference":[{"key":"2021011409044535900_bjs11159-bib-0001","doi-asserted-by":"crossref","first-page":"2","DOI":"10.3174\/ajnr.A4432","article-title":"Carotid near-occlusion: a comprehensive review, part 1 \u2013 definition, terminology, and diagnosis","volume":"37","author":"Johansson","year":"2016","journal-title":"AJNR Am J Neuroradiol"},{"key":"2021011409044535900_bjs11159-bib-0002","first-page":"2086","article-title":"Identification, prognosis, and management of patients with carotid artery near occlusion","volume":"26","author":"Fox","year":"2005","journal-title":"AJNR Am J Neuroradiol"},{"key":"2021011409044535900_bjs11159-bib-0003","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.ejvs.2017.06.021","article-title":"Editor's choice \u2013 management of atherosclerotic carotid and vertebral artery disease: 2017 clinical practice guidelines of the European Society for Vascular Surgery (ESVS)","volume":"55","author":"Naylor","year":"2018","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"2021011409044535900_bjs11159-bib-0004","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/S0140-6736(03)12228-3","article-title":"Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis","volume":"361","author":"Rothwell","year":"2003","journal-title":"Lancet"},{"key":"2021011409044535900_bjs11159-bib-0005","doi-asserted-by":"crossref","first-page":"1664","DOI":"10.1016\/j.avsg.2015.05.015","article-title":"Management of patients with internal carotid artery near-total occlusion: an updated meta-analysis","volume":"29","author":"Mylonas","year":"2015","journal-title":"Ann Vasc Surg"},{"key":"2021011409044535900_bjs11159-bib-0006","doi-asserted-by":"crossref","first-page":"b2535","DOI":"10.1136\/bmj.b2535","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"339","author":"Moher","year":"2009","journal-title":"BMJ"},{"key":"2021011409044535900_bjs11159-bib-0007","volume-title":"The Newcastle\u2013Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-analysis","author":"Wells"},{"key":"2021011409044535900_bjs11159-bib-0008","first-page":"147","article-title":"Pseudo-occlusion of the internal carotid artery: report of 15 cases and review of the literature","volume":"16","author":"Regina","year":"1997","journal-title":"et al"},{"key":"2021011409044535900_bjs11159-bib-0009","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.avsg.2009.07.010","article-title":"Eversion carotid endarterectomy versus best medical treatment in symptomatic patients with near total internal carotid occlusion: a prospective nonrandomized trial","volume":"24","author":"Radak","year":"2010","journal-title":"Ann Vasc Surg"},{"key":"2021011409044535900_bjs11159-bib-0010","doi-asserted-by":"crossref","first-page":"252","DOI":"10.3174\/ajnr.A2285","article-title":"Internal carotid artery stenting in patients with near occlusion: 30-day and long-term outcome","volume":"32","author":"Gonz\u00e1lez","year":"2011","journal-title":"AJNR Am J Neuroradiol"},{"key":"2021011409044535900_bjs11159-bib-0011","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1159\/000324385","article-title":"Outcomes associated with carotid pseudo-occlusion","volume":"31","author":"Ogata","year":"2011","journal-title":"Cerebrovasc Dis"},{"key":"2021011409044535900_bjs11159-bib-0012","doi-asserted-by":"crossref","first-page":"1512","DOI":"10.1016\/j.jvs.2013.05.103","article-title":"Cerebral hemodynamic benefits after carotid artery stenting in patients with near occlusion","volume":"58","author":"Oka","year":"2013","journal-title":"J Vasc Surg"},{"key":"2021011409044535900_bjs11159-bib-0013","doi-asserted-by":"crossref","first-page":"1976","DOI":"10.1016\/j.clineuro.2013.06.001","article-title":"Carotid artery stenting in patients with near occlusion: a single-center experience and comparison with recent studies","volume":"115","author":"Son","year":"2013","journal-title":"Clin Neurol Neurosurg"},{"key":"2021011409044535900_bjs11159-bib-0014","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1007\/s10143-013-0481-y","article-title":"Carotid artery stenting using the proximal or dual protection method for near occlusion of the cervical internal carotid artery","volume":"36","author":"Sakamoto","year":"2013","journal-title":"Neurosurg Rev"},{"key":"2021011409044535900_bjs11159-bib-0015","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1111\/joim.12318","article-title":"Symptomatic carotid near-occlusion with full collapse might cause a very high risk of stroke","volume":"277","author":"Johansson","year":"2015","journal-title":"J Intern Med"},{"key":"2021011409044535900_bjs11159-bib-0016","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1227\/NEU.0000000000001345","article-title":"Angiographic characteristics of pseudo-occlusion of the internal carotid artery before and after stenting","volume":"79","author":"Matsuda","year":"2016","journal-title":"Neurosurgery"},{"key":"2021011409044535900_bjs11159-bib-0017","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1177\/1747493017714177","article-title":"Stroke Project of the Spanish Cerebrovascular Diseases Study Group. Early risk of recurrent stroke in patients with symptomatic carotid near-occlusion: results from CAOS, a multicenter registry study","volume":"12","author":"Garc\u00eda-Pastor","year":"2017","journal-title":"Int J Stroke"},{"key":"2021011409044535900_bjs11159-bib-0018","doi-asserted-by":"crossref","first-page":"1900","DOI":"10.1007\/s00415-018-8939-z","article-title":"Carotid endarterectomy in patients with recurrent symptoms associated with an ipsilateral carotid artery near occlusion with full collapse","volume":"265","author":"Meershoek","year":"2018","journal-title":"J Neurol"},{"key":"2021011409044535900_bjs11159-bib-0019","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1212\/WNL.48.4.911","article-title":"The risks and benefits of carotid endarterectomy in patients with near occlusion of the carotid artery. North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group","volume":"48","author":"Morgenstern","year":"1997","journal-title":"Neurology"},{"key":"2021011409044535900_bjs11159-bib-0020","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1161\/01.STR.31.3.622","article-title":"Low risk of ischemic stroke in patients with reduced internal carotid artery lumen diameter distal to severe symptomatic carotid stenosis: cerebral protection due to low poststenotic flow? On behalf of the European Carotid Surgery Trialists' Collaborative Group","volume":"31","author":"Rothwell","year":"2000","journal-title":"Stroke"},{"key":"2021011409044535900_bjs11159-bib-0021","first-page":"632","article-title":"Diagnosing carotid stenosis near-occlusion by using CT angiography","volume":"27","author":"Bartlett","year":"2006","journal-title":"AJNR Am J Neuroradiol"},{"key":"2021011409044535900_bjs11159-bib-0022","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1002\/bjs.10717","article-title":"Meta-analysis of the procedural risks of carotid endarterectomy and carotid artery stenting over time","volume":"105","author":"Lokuge","year":"2018","journal-title":"Br J Surg"}],"container-title":["British Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fbjs.11159","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/bjs.11159","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/bjs.11159","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/academic.oup.com\/bjs\/article-pdf\/106\/6\/665\/35759541\/bjs11159.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/bjs\/article-pdf\/106\/6\/665\/35759541\/bjs11159.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,20]],"date-time":"2021-05-20T14:21:51Z","timestamp":1621520511000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjs\/article\/106\/6\/665-671\/6092899"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4,11]]},"references-count":22,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2019,4,11]]},"published-print":{"date-parts":[[2019,4,11]]}},"URL":"https:\/\/doi.org\/10.1002\/bjs.11159","relation":{},"ISSN":["0007-1323","1365-2168"],"issn-type":[{"value":"0007-1323","type":"print"},{"value":"1365-2168","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2019,5]]},"published":{"date-parts":[[2019,4,11]]}}}