Age differential between outcomes of carotid angioplasty and stent placement and carotid endarterectomy in general practice

Background: Atrial fibrillation (AF) is a relatively common comorbid condition among patients who undergo carotid endarterectomy (CEA) and carotid artery stent placement (CAS); however the outcomes of patients with AF undergoing CAS have not been fully examined. We sought to investigate the impact of AF on in-hospital outcomes of CEA and CAS in general practice. Methods: We analyzed the data from the Nationwide Inpatient Sample (NIS), which is representative of all admissions in the United States from 2005 to 2009. The primary end point was postoperative stroke, cardiac complications, postoperative mortality, and composite of these endpoints. Multivariate regression analysis was performed to determine the 1/. the association of AF (compared to without AF); and 2/. the association of CEA (compared with CAS) with the occurrence of postoperative stroke, cardiac complication or death. Covariates included in the logistic regression were patient’s gender, age, ethnicity, comorbid conditions, symptom status (symptomatic vs asymptomatic status), and hospital characteristics. Results: Of the total 672,074 patients who underwent CAS or CEA, 8.8% of the procedures were performed in patients with AF. For patients undergoing CEA, AF was associated with an increased risk of postoperative stroke (P<0.0001; OR, 1.57: 95% CI, 1.32-1.86) but not in patients undergoing CAS. The relative risk of composite endpoint of postoperative stroke, cardiac complications, and mortality was increased in patients with AF undergoing CAS (OR 1.43, 95% CI 1.18-1.74) and those undergoing CEA (OR 3.18, 95% CI 2.89-3.49). After adjustment for potential confounders, the odds of composite endpoint of postoperative stroke, cardiac complications, and mortality (OR, 1.31, 95% CI 1.08 - 1.59) were significantly higher among patients who underwent CEA (compared with those who underwent CAS). An inverse relationship was seen in patients without AF in whom the composite endpoint was significantly lower in patients undergoing CEA. Conclusion: Our analysis suggests that almost 10% of CAS and CEA are performed in patients with AF in general practice, and higher rates of adverse events are observed among these patients particularly those undergoing CEA.

Download Full-text

The proven non-inferiority of carotid angioplasty and stent placement (CAS) versus carotid endarterectomy (CEA)

PharmacoEconomics & Outcomes News ◽

10.2165/00151234-200905730-00026 ◽

2009 ◽

Vol 573 (1) ◽

pp. 9-9

Keyword(s):

Carotid Endarterectomy ◽

Stent Placement ◽

Carotid Angioplasty

Download Full-text

Carotid angioplasty and stenting for recurrent and radiation-induced stenosis: preliminary experience

Neurosurgical FOCUS ◽

10.3171/foc.1998.5.4.17 ◽

1998 ◽

Vol 5 (4) ◽

pp. E16 ◽

Cited By ~ 6

Author(s):

Ronald P. Benitez ◽

Rocco A. Armonda ◽

James Harrop ◽

Jeffrey E. Thomas ◽

Robert H. Rosenwasser

Keyword(s):

Carotid Endarterectomy ◽

Stent Placement ◽

Carotid Bifurcation ◽

Occlusive Disease ◽

Surgical Patient ◽

Carotid Angioplasty ◽

Asymptomatic Group ◽

Symptomatic Carotid ◽

Radiation Induced

Carotid endarterectomy for atherosclerotic occlusive disease has become the standard of care for the treatment of symptomatic and asymptomatic occlusive disease of the carotid bifurcation, based on the results of the North American Symptomatic Carotid Endarterectomy Trial, as well as the Asymptomatic Carotid Atherosclerosis Study. For surgical treatment to be of benefit, the perioperative complication rate for neurological events should be 6% or less in the symptomatic population and 3% or less in the asymptomatic group. The performance of carotid endarterectomy for recurrent stenosis and radiation-induced stenosis has reported neurological events ranging from 4 to 10%. It is in this particular population that carotid angioplasty and stent placement may play a role. The authors performed a retrospective analysis of 11 patients who underwent carotid angioplasty and stent placement for recurrent or radiation-induced stenosis. One patient in whom endarterectomy was performed by the vascular surgery service had a critical stenosis distal to the endarterectomy site and awoke with a neurological deficit. This patient underwent reexploration and placement of a stent in the artery distal to the arteriotomy site. The follow-up period ranged from 7 to 12 months. Patient age ranged from 65 to 77 years (mean 75 years). Five of eight patients underwent angioplasty and stent placement for recurrent atherosclerotic disease. Two patients had radiation-induced stenosis, and one patient had a stent placed intraoperatively. All patients, with the exception of the one who underwent intraoperative stent placement, had posttreatment stenoses of less than 15%. The surgical patient had a 30% residual stenosis distally. There were no intra- or postoperative transient ischemic attacks, major or minor strokes, or deaths. Patients who have recurrent or radiation-induced stenosis are potential candidates for angioplasty and stent placement. Before this can be recommended as an alternative to surgical correction, a longer follow-up period is required.

Download Full-text

Cervical Carotid Revascularization: The Case for Carotid Angioplasty with Stenting

Neurosurgery ◽

10.1227/01.neu.0000237457.79690.11 ◽

2006 ◽

Vol 59 (suppl_5) ◽

pp. S3-228-S3-241

Author(s):

Ricardo A. Hanel ◽

Elad I. Levy ◽

L. Nelson Hopkins

Keyword(s):

Carotid Artery ◽

Carotid Endarterectomy ◽

Stent Placement ◽

Selection Criteria ◽

Carotid Stenting ◽

Carotid Angioplasty ◽

Carotid Revascularization ◽

Endovascular Revascularization ◽

Intervention Trials

Abstract CAROTID ARTERY ANGIOPLASTY with or without stent placement has evolved as an alternative to carotid endarterectomy, particularly for those patients in whom carotid endarterectomy is associated with a higher risk of complications. This article summarizes the selection criteria for participation in and the results of several carotid intervention trials, reviews the relative indications and limitations for both surgical and endovascular revascularization approaches, and describes the technique for and results associated with carotid stenting. The discussion is presented from the vantage of neurosurgeons who are experienced in both revascularization approaches.

Download Full-text