24 research outputs found

    Status Update and Interim Results from the Asymptomatic Carotid Surgery Trial-2 (ACST-2)

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    Objectives: ACST-2 is currently the largest trial ever conducted to compare carotid artery stenting (CAS) with carotid endarterectomy (CEA) in patients with severe asymptomatic carotid stenosis requiring revascularization. Methods: Patients are entered into ACST-2 when revascularization is felt to be clearly indicated, when CEA and CAS are both possible, but where there is substantial uncertainty as to which is most appropriate. Trial surgeons and interventionalists are expected to use their usual techniques and CE-approved devices. We report baseline characteristics and blinded combined interim results for 30-day mortality and major morbidity for 986 patients in the ongoing trial up to September 2012. Results: A total of 986 patients (687 men, 299 women), mean age 68.7 years (SD ± 8.1) were randomized equally to CEA or CAS. Most (96%) had ipsilateral stenosis of 70-99% (median 80%) with contralateral stenoses of 50-99% in 30% and contralateral occlusion in 8%. Patients were on appropriate medical treatment. For 691 patients undergoing intervention with at least 1-month follow-up and Rankin scoring at 6 months for any stroke, the overall serious cardiovascular event rate of periprocedural (within 30 days) disabling stroke, fatal myocardial infarction, and death at 30 days was 1.0%. Conclusions: Early ACST-2 results suggest contemporary carotid intervention for asymptomatic stenosis has a low risk of serious morbidity and mortality, on par with other recent trials. The trial continues to recruit, to monitor periprocedural events and all types of stroke, aiming to randomize up to 5,000 patients to determine any differential outcomes between interventions. Clinical trial: ISRCTN21144362. © 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved

    A multiscale model for tropical intraseasonal oscillations

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    The tropical intraseasonal 40- to 50-day oscillation (TIO) is the dominant component of variability in the tropical atmosphere with remarkable planetary-scale circulation generated as envelopes of complex multiscale processes. A new multiscale model is developed here that clearly demonstrates the fashion in which planetary-scale circulations sharing many features in common with the observational record for the TIO are generated on intraseasonal time scales through the upscale transfer of kinetic and thermal energy generated by wave trains of organized synoptic-scale circulations having features in common with observed superclusters. The appeal of the multiscale models developed below is their firm mathematical underpinnings, simplicity, and analytic tractability while remaining self-consistent with key features of the observational record. The results below demonstrate, in a transparent fashion, the central role of organized vertically tilted synoptic-scale circulations in generating a planetary circulation resembling the TIO
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