Systematic review and network meta-analysis of treatment strategies for asymptomatic carotid disease.

We aim to perform a systematic review and meta-analysis to investigate outcomes of treatment strategies for asymptomatic carotid disease. We searched electronic bibliographic sources (MEDLINE, EMBASE, CINAHL and CENTRAL) to identify randomised controlled trials (RCT) reporting comparative outcomes of carotid endarterectomy (CEA), carotid stenting (CAS) and best medical therapy (BMT) in asymptomatic carotid disease. We performed pairwise meta-analysis applying random or fixed-effects models and reported the results as the odds ratio (OR) or risk difference (RD) and 95% confidence interval (CI). We also performed a network meta-analysis and obtained a hierarchy of the competing interventions using rankograms and the surface under the cumulative ranking curve and mean ranks. Stroke and death within 30 days and during follow up were the primary outcome endpoints. Eleven RCTs were identified reporting a total of 8,954 patients. Compared to BMT, CEA reduces the odds of long-term mortality (OR 0.70, 95% CI 0.43, 1.12) and ipsilateral stroke (OR 0.59 95% CI 0.50, 0.71). Network meta-analyses league table demonstrated that BMT is superior to CEA and CAS in terms of perioperative stroke risk and mortality. CEA is the preferred method to reduce the long-term risk of ipsilateral stroke and mortality for patients with asymptomatic carotid disease

Improving post-EVAR surveillance with a smart stent-graft

Abdominal aortic aneurysms (AAA or triple A’s) are indolent and deadly diseases. Their treatment options involve either an invasive procedure or a minimally invasive one. When the minimally invasive procedure, endovascular aneurysm repair (EVAR), was introduced, it revolutionized the treatment of AAA’s due to advantages such as shortened hospital stays and reduced costs. As EVAR requires periodic imaging exams, questions are nowadays being raised regarding the procedure’s long-term cost-benefit relation. In order to reduce followup costs, new technological solutions are being pursued, namely EVAR stentgrafts with sensing capabilities. In this chapter, the suitability of aneurysm sac pressure measurement for EVAR surveillance is evaluated using an AAA computer model. In addition the design drivers underlying EVAR stent-grafts are reviewed and the development of a new flexible pressure sensor integrated into a stent-graft is described.Fundação para a Ciência e a Tecnologia (FCT