Carotid artery stenting versus endarterectomy in relation to perioperative myocardial ischemia, troponin T release and major cardiac events

Objective: Malnutrition is associated with poor clinical outcomes in many diseases. The Controlling Nutritional Status (CONUT) is an objective index used for evaluating nutritional status of hospitalized patients. The aim of this study was to investigate the relationship between malnutrition assessed by CONUT score and the prognosis in patients undergoing carotid artery stenting (CAS). Methods: The study included 170 patients who underwent CAS due to symptomatic or asymptomatic severe carotid artery stenosis. Median follow-up period was 50 (interquartile range [IQR], 41-60) months. Patients were divided into two groups according to the CONUT score: (i) normal nutrition (<2) and (ii) malnutrition (≥2). Primary endpoint was accepted as MACE (major adverse cardiac events) including all-cause death and ischemic stroke. Results:The prevalence of MACE was significantly higher in the malnutrition group (p=0.001). Kaplan Meier analysis showed lower survival rates in the malnutrition group (log rank = 9.36, p=0.002; Figure 4). In multivariate logistic regression analysis, age and CONUT score were independent predictors of all-cause death and stroke after adjustment for confounding factors, respectively, (OR: 1.058, 95% CI: 1.013-1.105, p=0.011, OR: 1.318, 95% CI: 1.017-1.881, p=0.039). Conclusion: Higher CONUT scores were associated with adverse outcomes in patients with CAS. Malnutrition assessed by the CONUT score may provide valuable prognostic information in patients with CAS.

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Carotid Artery Stenting in Patients with Atrial Fibrillation: Direct Oral Anticoagulants, Brief Double Antiplatelets, and Testing Strategy

Journal of Clinical Medicine ◽

10.3390/jcm10225242 ◽

2021 ◽

Vol 10 (22) ◽

pp. 5242

Author(s):

José E. Cohen ◽

John Moshe Gomori ◽

Asaf Honig ◽

Ronen R. Leker

Keyword(s):

Atrial Fibrillation ◽

Carotid Artery ◽

Carotid Artery Stenting ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Hemodynamic Instability ◽

Minor Stroke ◽

Cardiac Events ◽

Therapy Effectiveness ◽

Ica Stenosis

Carotid endarterectomy is usually preferred over carotid artery stenting (CAS) for patients with atrial fibrillation (AF). We present our experience with short-course periprocedural triple antithrombotic therapy in 32 patients aged >18 years with nonvalvular AF undergoing CAS. There were no deaths, cardiac events, embolic strokes, hyperperfusion syndrome, intracranial hemorrhage, or stent thrombosis within 30 days. Transient intraprocedural hemodynamic instability in 15/32 (47%) and prolonged instability in 4/32 (13%) was managed conservatively. At a mean 16-month follow-up, there were no new neurological events or deterioration. Mean stenosis was reduced from 78.0% ± 9.7% to 17.3% ± 12.2%. This retrospective study included patients AF who were symptomatic (minor stroke (NIHSS ≤ 5)/TIA) with ICA stenosis >50%, or asymptomatic under DOAC therapy with carotid stenosis >80%, who underwent CAS from 6/2014–10/2020. Patients received double antiplatelets and statins. Antiplatelet therapy effectiveness was monitored. Stenting was performed when P2Y12 reaction units (PRU) were <150. DOACs were discontinued 48 h before angioplasty; one 60 mg dose of subcutaneous enoxaparin was administered in lieu. DOAC was restarted 12–24 h after intervention. Patients were discharged under DOAC and one nonaspirin antiplatelet. 32 patients on DOAC were included (26 male, mean age 71). 19 (59.4%) presented with stroke (ICA stenosis-related in 14); 13 (40.6%) were asymptomatic. Stents were deployed under filter protection following pre-angioplasty; post-angioplasty was performed at least once in 12 patients (37.5%). Our experience suggests that CAS can be safely performed in selected patients with CAS and AF requiring DOAC. The role of CAS in AF patients under DOAC warrants study in rigorous trials.

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