The Impact of Race on In-hospital Stroke/Death After Carotid Artery Stenting

BackgroundWhile dual antiplatelet therapy (dAPT) is standard of care following carotid artery stenting (CAS), the optimal dAPT regimen and duration has not been established.MethodsWe canvassed a large national database (IBM MarketScan) to identify patients receiving carotid endarterectomy (CEA) or CAS for treatment of ischemic stroke or carotid artery stenosis from 2007 to 2016. We performed univariable and multivariable regression methods to evaluate the impact of covariates on post-CAS stroke-free survival, including post-discharge antiplatelet therapy.ResultsA total of 79 084 patients diagnosed with ischemic stroke or carotid stenosis received CEA (71 178; 90.0%) or CAS (7906; 10.0%). After adjusting for covariates, <180 days prescribed post-CAS P2Y12-inhibition was associated with increased risk for stroke (<90 prescribed days HR=1.421, 95% CI 1.038 to 1.946; 90–179 prescribed days HR=1.484, 95% CI 1.045 to 2.106). The incidence of hemorrhagic complications was higher during the period of prescribed P2Y12-inhibition (1.16% per person-month vs 0.49% per person-month after discontinuation, P<0.001). The rate of extracranial hemorrhage was nearly six-fold higher while on dAPT (6.50% per patient-month vs 1.16% per patient-month, P<0.001), and there was a trend towards higher rate of intracranial hemorrhage that did not reach statistical significance (5.09% per patient-month vs 3.69% per patient-month, P=0.0556). Later hemorrhagic events beyond 30 days post-CAS were significantly more likely to be extracranial (P=0.028).ConclusionsIncreased duration of post-CAS dAPT is associated with lower rates of readmissions for stroke, and with increased risk of hemorrhagic complications, particularly extracranial hemorrhage. The potential benefit of prolonging dAPT with regard to ischemic complications must be balanced with the corresponding increased risk of predominantly extracranial hemorrhagic complications.

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Expression of P-selectin, von Willebrand and endothelin-1 after carotid artery stenting

VASA ◽

10.1024/0301-1526/a000094 ◽

2011 ◽

Vol 40 (3) ◽

pp. 199-204 ◽

Cited By ~ 8

Author(s):

Xia ◽

Yang ◽

Qu ◽

Cheng ◽

Wang

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenting ◽

Endothelin 1 ◽

Significant Difference ◽

Group 2 ◽

One Year ◽

Von Willebrand ◽

The Impact ◽

Group 1

Background: This study was designed to investigate the impact of carotid artery stenting (CAS) on plasma levels of P-selectin, von Willebrand (vWF) and endothelin-1. Patients and methods: Sixty-seven patients who received CAS were divided into group 1 (one stent for a simple lesion, n = 38) and group 2 (two stents for complex lesions, n = 29). The levels of P-selectin, vWF and endothelin-1 were measured before CAS, 1 h, 6h, 24 h and 2 weeks after the stenting. Results: Sixty-one patients completed one-year follow up. Restenosis was noted in 14 (23 %) patients, among these three (4.8 %) had a restenosis of > 50 % of the vascular lumen. In all patients, the levels of P-selectin, vWF and endothelin-1 increased immediately after CAS (P < 0.05 or < 0.01). The levels of vWF and endothelin-1 in group 2 were higher than in group 1 (P < 0.05 or 0.01). There was no significant difference in P-selectin and endothelin-1 between the restenosis and non-restenosis group (P > 0.05). The 24 h vWF in patients with restenosis were higher than in non-restenosis group (P < 0.05). Conclusions: CAS results in a significant increase in plasma P-selectin, vWF and endothelin-1. The post-CAS levels of P-selectin, vWF and endothelin-1 are related to the extent of endothelial injury. Whether they are associated with restenosis 12 months after the treatment requires further investigation.

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Abstract WP133: Long-term Outcomes of Carotid Endarterectomy and Carotid Artery Stenting: Real-World Status of Single Institute in Japan

Stroke ◽

10.1161/str.47.suppl_1.wp133 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Kohkichi Hosoda ◽

Taichiro Imahori ◽

Atsushi Fujita ◽

Yusuke Yamamoto ◽

Hidehito Kimura ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Endarterectomy ◽

Real World ◽

Carotid Artery Stenting ◽

Long Term Outcomes ◽

End Point ◽

Bilateral Carotid ◽

Free Rate ◽

Stroke Death

Introduction: We investigated long-term outcomes of carotid endarterectomy (CEA) and carotid artery stenting (CAS) in our hospital to assess the outcomes of real-world practice in single institute of Japan. Methods: Between August 2006 and July 2014, 236 consecutive carotid revascularizations with either CEA or CAS were performed in our institute. The initial treatment was regarded as the starting point in the cases of the patients who received treatment by bilateral carotid artery stenosis or retreatment. We assessed the long-term outcomes with survival analyses. Results: A total of 210 patients (CEA 128, CAS 82), including 94 symptomatic patients, were enrolled in the current study with mean follow-up period of 45.8 months. The periprocedural stroke/death/myocardial infarction (MI) rate was 3.1% for CEA and 4.9% for CAS groups (p=0.71). Estimates of the 4-year event-free rate from the primary end point (the composite of any stroke, death, or MI within 30 days and any ipsilateral stroke thereafter) using competing risk analysis were 3.1% for CEA and 8.6% for CAS (P=0.041). Kaplan-Meier estimates of the 4-year event-free rate from the secondary end point (the composite of any stroke, death, or MI within 30 days and any stroke or death thereafter) were 12.8% for CEA and 20.1% for CAS (P=0.051). Age (Hazard ratio [HR], 1.14/year [95%CI, 1.03-1.26]; p = 0.012) and CAS (HR, 3.5 [95%CI, 1.05-11.5]; p = 0.04 ) were significant predictors for the primary end point in multivariate analysis. For the secondary end point, age (HR, 2.1/10year [95%CI, 1.27-3.47]; p = 0.004) and CAS (HR, 2.0 [95%CI, 1.04-3.83], p = 0.037) were significant predictors. The inclusion of higher risk patients in the CAS group may have been the reason for CAS being a risk factor. Conclusion: The current study on real-world practices demonstrated perioperative and long-term outcomes that were comparable to previous major studies of large numbers of patients.

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