scholarly journals Comparing Perioperative and Long-term Outcomes of Urgent, Early, or Late Carotid Revascularization Among Patients With Symptomatic Carotid Artery Stenosis

2020 ◽  
Vol 72 (1) ◽  
pp. e111-e113
Author(s):  
Christina Cui ◽  
Hanaa Dakour-Aridi ◽  
Jinny J. Lu ◽  
Isaac N. Naazie ◽  
Marc L. Schermerhorn ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Long Term Outcomes ◽  
Carotid Revascularization ◽  
Symptomatic Carotid

Long-Term Outcomes of Carotid Endarterectomy and Carotid Artery Stenting When Performed by a Single Vascular Surgeon

2019 ◽  
Vol 53 (3) ◽  
pp. 216-223 ◽  
Author(s):  
Muhammad Rizwan ◽  
Hanaa Dakour Aridi ◽  
Tru Dang ◽  
Widian Alshwaily ◽  
Besma Nejim ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Carotid Artery Stenting ◽  
Artery Stenosis ◽  
Long Term Outcomes ◽  
Vascular Surgeon ◽  
Free Survival ◽  
Carotid Revascularization ◽  
Short And Long Term

Objectives: Carotid artery endarterectomy (CEA) and carotid artery stenting (CAS) are 2 effective treatment options for carotid revascularization and stroke prevention. The long-term outcomes of Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) reported similar stroke and death rate between the 2 procedures. This study presents the short- and long-term outcomes of CEA and CAS of all risk patients performed by a single vascular surgeon in a real-world setting. Methods: We retrospectively reviewed all patients who underwent CEA and CAS from September 2005 to June 2017 at our institute. Student t test, χ2, and Fisher exact tests were used to compare patient’s characteristics. Multivariate logistic, cox regression models and survival analysis were used to compare postoperative and long-term outcomes between the 2 groups. Results: Over 2000 patients were evaluated for carotid artery stenosis during the study period, and 313 revascularization procedures were performed (CEA: 47%, CAS: 53%). Patients’ age (Mean [95% confidence interval, CI] 68.8 [67.2-70.4] vs 69.7 [68.2-71.3], P = .40) was similar between CEA and CAS. Patients who underwent CAS had significantly higher comorbidities (chronic obstructive pulmonary disease [COPD], chronic heart failure [CHF], hyperlipidemia, and prior ipsilateral intervention, all P < .05). No difference was found in 30-day complications after CEA versus CAS including stroke (2.0% vs 1.2%), myocardial infarction (MI; 0.7% vs 1.2%), death (0% vs 1.2%) as well as combined major adverse events (stroke/death/MI; 2.7% vs 3.0%; all P > .05). Overall 7-year survival, stroke-free survival and restenosis-free survival were similar between the 2 groups ( P > .5). Significant predictors of mortality were diabetes (hazard ratio, HR [95% CI]: 2.41 [1.15-5.08]), chronic kidney disease (HR [95% CI]: 4.89 [1.97-12.13]), and COPD (HR [95% CI]: 3.31 [1.43-7.71]; all P values <.05). Statin use was protective with 71% reduction in risk of mortality (HR [95% CI]: 0.29 [0.12-0.67], P = .004). Conclusion: Our experience showed comparable short- and long-term outcomes of CAS and CEA performed for carotid artery stenosis by vascular surgeon. There was no difference between single institutional long-term outcomes and CREST outcomes following CEA and CAS.

In-Hospital Outcomes of Urgent, Early, or Late Revascularization for Symptomatic Carotid Artery Stenosis

Stroke ◽  
2021 ◽  
Author(s):  
Christina L. Cui ◽  
Hanaa Dakour-Aridi ◽  
Jinny J. Lu ◽  
Kevin S. Yei ◽  
Marc L. Schermerhorn ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Carotid Stenting ◽  
Artery Stenosis ◽  
Optimal Timing ◽  
Hospital Outcomes ◽  
Carotid Revascularization ◽  
Symptomatic Carotid ◽  
Revascularization Procedures ◽  
Stroke Death

Background and Purpose: Advancements in carotid revascularization have produced promising outcomes in patients with symptomatic carotid artery stenosis. However, the optimal timing of revascularization procedures after symptomatic presentation remains unclear. The purpose of this study is to compare in-hospital outcomes of transcarotid artery revascularization (TCAR), transfemoral carotid stenting (TFCAS), or carotid endarterectomy (CEA) performed within different time intervals after most recent symptoms. Methods: This is a retrospective cohort study of United States patients in the vascular quality initiative. All carotid revascularizations performed for symptomatic carotid artery stenosis between September 2016 and November 2019 were included. Procedures were categorized as urgent (0–2 days after most recent symptom), early (3–14 days), or late (15–180 days). The primary outcome of interest was in-hospital stroke and death. Secondary outcomes include in-hospital stroke, death, and transient ischemic attacks. Multivariable logistic regression was used to compare outcomes. Results: A total of 18 643 revascularizations were included: 2006 (10.8%) urgent, 7423 (39.8%) early, and 9214 (49.42%) late. Patients with TFCAS had the highest rates of stroke/death at all timing cohorts (urgent: 4.0% CEA, 6.9% TFCAS, 6.5% TCAR, P =0.018; early: 2.5% CEA, 3.8% TFCAS, 2.9% TCAR, P =0.054; late: 1.6% CEA, 2.8% TFCAS, 2.3% TCAR, P =0.003). TFCAS also had increased odds of in-hospital stroke/death compared with CEA in all 3 groups (urgent adjusted odds ratio [aOR], 1.7 [95% CI, 1.0–2.9] P =0.03; early aOR, 1.6 [95% CI, 1.1–2.4] P =0.01; and late aOR, 1.9 [95% CI, 1.2–3.0] P =0.01). TCAR and CEA had comparable odds of in-hospital stroke/death in all 3 groups (urgent aOR, 1.9 [95% CI, 0.9–4], P =0.10), (early aOR, 1.1 [95% CI, 0.7–1.7], P =0.66), (late aOR, 1.5 [95% CI, 0.9–2.3], P =0.08). Conclusions: CEA remains the safest method of revascularization within the urgent period. Among revascularization performed outside of the 48 hours, TCAR and CEA have comparable outcomes.

scholarly journals Perioperative and Long-term Outcomes of Carotid Endarterectomy for Japanese Asymptomatic Cervical Carotid Artery Stenosis: A Single Institution Study

2015 ◽  
Vol 55 (11) ◽  
pp. 830-837 ◽  
Author(s):  
Taichi ISHIGURO ◽  
Taku YONEYAMA ◽  
Tatsuya ISHIKAWA ◽  
Koji YAMAGUCHI ◽  
Akitsugu KAWASHIMA ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Long Term Outcomes ◽  
Single Institution

Carotid Artery Stenting May Be Losing the Battle against Carotid Endarterectomy for the Management of Symptomatic Carotid Artery Stenosis, But the Jury Is Still Out

Vascular ◽  
2009 ◽  
Vol 17 (4) ◽  
pp. 183-189 ◽  
Author(s):  
Kosmas I. Paraskevas ◽  
Dimitri P. Mikhailidis ◽  
Frank J. Veith
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Carotid Artery Stenosis ◽  
Carotid Artery Stenting ◽  
Artery Stenosis ◽  
Long Term Results ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis

Carotid artery stenting (CAS) has emerged as a potential alternative to carotid endarterectomy (CEA) for the management of carotid artery stenosis. The purpose of this article is to provide an evaluation and critical overview of the trials comparing the early and later results of CAS with CEA for symptomatic carotid stenosis. The Cochrane Controlled Trials Register, PubMed/Medline, and EMBASE databases were searched up to February 1, 2009, to identify trials comparing the long-term outcomes of CAS with CEA. The MeSH terms used were “carotid artery stenting,” “carotid endarterectomy,” “symptomatic carotid artery stenosis,” “treatment,” “clinical trial,” “randomized,” and “long-term results,” in various combinations. One single-center and three multicenter randomized studies reporting their long-term results from the comparison of CAS with CEA for symptomatic carotid stenosis were identified. All four studies independently reached the conclusion that CAS may not provide results equivalent to those of CEA for the management of symptomatic carotid stenosis. A higher incidence of recurrent stenosis and peri- and postprocedural events accounted for the inferior results reported for CAS compared with CEA. Current data from randomized studies indicate that CAS provides inferior long-term results compared with CEA for the management of symptomatic carotid artery stenosis. However, it can be argued that all of these trials were performed when both CAS equipment and CAS operators had not evolved to their current status. Given that current equipment and mature experience are required for CAS before comparing it with the current “gold standard” procedure (CEA), the results of soon-to-be reported trials (Carotid Revascularization Endarterectomy vs Stenting Trial [CREST], International Carotid Stenting Study [ICSS], or others) may alter the current impression that CAS is inferior to CEA for the treatment of symptomatic carotid stenosis.

scholarly journals Long-Term Results of Carotid Artery Stents to Manage Symptomatic Carotid Artery Stenosis and Factors That Affect Outcome

2010 ◽  
Vol 3 (1) ◽  
pp. 50-56 ◽  
Author(s):  
Marc S. Randall ◽  
Fiona M. McKevitt ◽  
Sanjeev Kumar ◽  
Trevor J. Cleveland ◽  
Keith Endean ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Long Term Results ◽  
Symptomatic Carotid ◽  
Carotid Artery Stents

Comparative outcomes of carotid artery stenting for asymptomatic and symptomatic carotid artery stenosis: a single-center prospective study

2014 ◽  
Vol 8 (2) ◽  
pp. 126-129 ◽  
Author(s):  
Dapeng Mo ◽  
Bo Wang ◽  
Ning Ma ◽  
Feng Gao ◽  
Zhongrong Miao
Keyword(s):  
Myocardial Infarction ◽  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Carotid Artery Stenting ◽  
Artery Stenosis ◽  
Acute Thrombosis ◽  
Symptomatic Carotid ◽  
Long Term Follow Up

BackgroundCarotid artery stenting (CAS) for symptomatic carotid artery stenosis (SCS) has been proved to be safe and effective in many randomized controlled trials, but the safety and efficacy of CAS for asymptomatic carotid artery stenosis (ACS) is not clear.ObjectiveTo prospectively compare the outcomes of CAS between patients with ACS and SCS.Methods402 consecutive patients, 233 with ACS and 169 with SCS, underwent CAS. The primary outcome was a composite of death, stroke or myocardial infarction at 30 days and during the follow-up period. Procedural success and complications such as hyperperfusion, sinus-cardiac reflex, gastrointestinal hemorrhage, myocardial infarction, acute thrombosis, and vagus nerve reflex were also compared between the ACS and SCS groups.ResultsCAS was successful in all patients. There were no significant differences in baseline characteristics of the patients (age, gender, hypertension, diabetes, smoking, alcohol consumption and dyslipidemia) and in 30-day or long-term follow-up outcomes between the ACS and SCS groups.ConclusionsPeriprocedural and long-term follow-up outcomes of CAS appear similar for ACS and SCS.

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