Comparison of 30-day readmission rates and risk factors between carotid artery stenting and endarterectomy

Background: While endovascular stroke treatment (EST) of large vessel occlusions in acute ischemic stroke (AIS) is proven to be safe and effective, there are subgroups of patients with increased rates of hemorrhages. Our goal was to identify risk factors for intracerebral hemorrhage and to assess whether acute carotid artery stenting (CAS) was associated with increased bleeding rates. Methods: We performed a retrospective analysis of our monocentric prospective stroke registry in the period from May 2010 to May 2018 and compared AIS patients receiving EST with (n = 73) versus without acute CAS (n = 548). Patients with intracranial stents, intra-arterial thrombolysis, or dissection of the carotid artery were excluded. Results: Parenchymal hemorrhage rates (PH2 according to the ECASS classification) and symptomatic hemorrhage (sICH) rates were increased in EST patients receiving CAS with odds being 6.3 (PH2) and 6.5 (sICH) times higher (PH2 17.8 vs. 3.3%, p < 0.001 and sICH: 16.4 vs. 2.9%, p < 0.001). Additional systemic thrombolysis with rtPA (IVRTPA) was no risk factor for cerebral hemorrhage (p = 0.213). Conclusion: AIS patients receiving EST with acute CAS and consecutive tirofiban or dual antiplatelet therapy suffered from an increased risk of relevant secondary intracranial bleeding. After adjusting for confounders, tirofiban and dual antiplatelet therapy were associated with higher bleeding rates.

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Risk Factors for Cerebral Embolization After Carotid Artery Stenting With Embolic Protection

Circulation Cardiovascular Interventions ◽

10.1161/circinterventions.112.000093 ◽

2013 ◽

Vol 6 (3) ◽

pp. 311-316 ◽

Cited By ~ 24

Author(s):

Klaudija Bijuklic ◽

Andreas Wandler ◽

Yuriy Varnakov ◽

Thilo Tuebler ◽

Joachim Schofer

Keyword(s):

Risk Factors ◽

Carotid Artery ◽

Carotid Artery Stenting ◽

Embolic Protection ◽

Cerebral Embolization

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Risk Factors Predictive of Carotid Artery Stenting–Associated Subclinical Microemboli

International Journal of Angiology ◽

10.1055/s-0031-1272546 ◽

2011 ◽

Vol 20 (01) ◽

pp. 025-032 ◽

Cited By ~ 7

Author(s):

Wei Zhou ◽

Rosa Zareie ◽

Maureen Tedesco ◽

Simin Gholibeikian ◽

Barton Lane ◽

...

Keyword(s):

Risk Factors ◽

Carotid Artery ◽

Carotid Artery Stenting

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Risk factors for hyperperfusion-induced intracranial hemorrhage after carotid artery stenting in patients with symptomatic severe carotid stenosis evaluation

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-013998 ◽

2018 ◽

Vol 11 (5) ◽

pp. 474-478 ◽

Cited By ~ 5

Author(s):

Lei Zhang ◽

Dongwei Dai ◽

Zifu Li ◽

Guoli Duan ◽

Yong-wei Zhang ◽

...

Keyword(s):

Risk Factors ◽

Carotid Artery ◽

Carotid Stenosis ◽

Intracranial Hemorrhage ◽

Carotid Artery Stenting ◽

Ct Perfusion ◽

Treatment Strategies ◽

Imaging Features ◽

Anterior Circulation ◽

Total Occlusion

BackgroundAnalyzing risk factors for hyperperfusion-induced intracranial hemorrhage (HICH) after carotid artery stenting (CAS) in patients with symptomatic severe carotid stenosis.MethodsThis study retrospectively analyzed clinical data of 210 patients, who had symptomatic severe carotid stenosis (70–99%) and received CAS treatment between June 2009 and June 2015, and evaluated the relationship of HICH with patients’ clinical baseline data, imaging features, and treatment strategies.ResultsSeven patients (3.3%) developed HICH after CAS. The incidence of HICH among patients with near total occlusion was significantly higher than among those without (10.1% vs 0%, P<0.001). Out of the seven, five had no development of either anterior or posterior circulations, and two had no development of anterior circulation and poor development of posterior circulation. Results showed that patients with poor compensation of Willis’ Circle were more likely to develop HICH compared with other patients (P<0.001). All patients received preoperative CT perfusion. TTP index was defined as the TTP ratio between the affected and contralateral side. The results showed that the TTP index was significantly different between the HICH group and non-HICH group (1.15±0.10 vs 1.30±0.15, P<0.001). An analysis of the ROC curve indicated that patients with TTP index >1.22 were more likely to develop HICH compared with other patients (sensitivity 100%, specificity 75.9%).ConclusionsPatients with severe unilateral carotid stenosis, the presence of near total occlusion, poor compensation of Willis’ Circle, and preoperative TTP index>1.22, have a higher risk of developing HICH after CAS.

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Comparison of nationwide trends in 30-day readmission rates after carotid artery stenting and carotid endarterectomy

Journal of Vascular Surgery ◽

10.1016/j.jvs.2019.06.190 ◽

2020 ◽

Vol 71 (4) ◽

pp. 1222-1232.e9 ◽

Cited By ~ 1

Author(s):

Sushruth Edla ◽

Varunsiri Atti ◽

Varun Kumar ◽

Byomesh Tripathi ◽

Saroj Neupane ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Endarterectomy ◽

Carotid Artery Stenting ◽

Readmission Rates

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Relationship between carotid plaque characteristics and new ischemic lesions after stenting detected by computed tomography angiography

Acta Radiologica ◽

10.1177/0284185119852732 ◽

2019 ◽

Vol 61 (1) ◽

pp. 47-55

Author(s):

Hongying Qu ◽

Xiaokun Zhang ◽

Miao Zhang ◽

Yongan Gao ◽

Jie Lu

Keyword(s):

Risk Factors ◽

Computed Tomography ◽

Carotid Artery ◽

Carotid Artery Stenting ◽

Carotid Plaque ◽

Diffusion Weighted Imaging ◽

Irregular Surface ◽

Irregular Surfaces ◽

Diffusion Weighted ◽

Peripheral Position

Background Although carotid artery stenting achieves definite benefits, it carries a higher rate of embolization compared with carotid endarterectomy. The incidence of embolization may be related to plaque stability. Purpose To assess for any relationship between plaque characteristics and cerebral emboli following carotid artery stenting. Material and Methods Sixty-three patients with severe carotid stenosis underwent carotid artery stenting. They were divided into two groups according to whether new ischemic lesions were detected on diffusion-weighted imaging after carotid artery stenting. We evaluated the types and locations of calcification in plaques and extent of calcification. We then assessed for a correlation between each of these factors and occurrence of new lesions on diffusion-weighted imaging after carotid artery stenting. Results The locations of calcification, percentage of plaque enhancement, and the number of plaques with irregular surface or ulceration were significantly different between the two groups. A peripheral position of calcification (close to the adventitia), enhancing plaques, and plaques with irregular surfaces or ulceration were statistically significant predictors of intracerebral embolization after carotid artery stenting. No significant differences in type of plaque or degree of calcification were found between two groups. Conclusion Peripheral calcification, enhancing plaques, and plaques with irregular surfaces were risk factors for intracerebral embolization after carotid artery stenting. These plaque characteristics should be considered when choosing the optimal treatment for patients.

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THIRTY-DAY READMISSION RATES OF CAROTID ENDARTERECTOMY VERSUS CAROTID ARTERY STENTING: A NATIONWIDE ANALYSIS

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(19)31746-2 ◽

2019 ◽

Vol 73 (9) ◽

pp. 1139

Author(s):

Varunsiri Atti ◽

Sushruth Edla ◽

Varun Kumar ◽

Byomesh Tripathi ◽

Nileshkumar Patel ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Endarterectomy ◽

Carotid Artery Stenting ◽

Readmission Rates

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Risk factors for new ischaemic cerebral lesions after carotid artery stenting: protocol for a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2019-030025 ◽

2019 ◽

Vol 9 (8) ◽

pp. e030025 ◽

Cited By ~ 2

Author(s):

Yao Feng ◽

Long Li ◽

Xuesong Bai ◽

Tao Wang ◽

Yanfei Chen ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Carotid Artery ◽

Systematic Reviews ◽

Carotid Artery Stenting ◽

Meta Analysis ◽

Primary Data ◽

Occurrence Rate ◽

Cochrane Library ◽

Cerebral Lesions

IntroductionNew ischaemic cerebral lesions (NICL) detected by diffusion-weighted imaging MRI are common after carotid artery stenting (CAS), with an occurrence rate ranging from 18% to 57%. Many studies reported occurrence of NICL could increase risk of future cerebrovascular events and cognitive impairment. However, controversies about determinants for occurrence of NICL after CAS exist among studies, and one risk factor embodied in an article may not be in another. Aim of this study is to introduce a protocol for a systematic review and meta-analysis to identify risk factors associated with occurrence of NICL after CAS.Methods and analysisAll relevant literature referring to risk factors for occurrence of NICL after CAS will be searched on the major databases, such as PubMed, Embase, Web of Science and the Cochrane Library until 31 December 2018. Literature, which must be randomised controlled trials, case–control studies or cohort studies, will be included in accordance with the prespecified eligibility criteria. The risk of bias will be assessed using the Cochrane Collaboration criteria and the quality of evidence will be assessed with the corresponding scale. Data will be extracted with a form prepared before and analysed using RevMan V.5.3 analyses software. Heterogeneity will be assessed using I2statistic. Our systematic review will be performed according to the guidance from the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.Ethics and disseminationThere is no need for ethical approval because primary data will not be attained. The systematic review will be presented at international conferences and published in peer-reviewed journals.PROSPERO registration numberCRD42019121129

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