Abstract P489: Differences in Characteristics of Octogenarian Patients Undergoing Carotid Artery Stenting and Carotid Endarterectomy for Carotid Stenosis: Insights From a Real World Surgical Quality Registry

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Mohammed Ali Alvi ◽  
Yagiz Yolcu ◽  
Kenan Rajjoub ◽  
Ozan Dikilitas
Keyword(s):  
High Risk ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Real World ◽  
Carotid Artery Stenting ◽  
Real World Data ◽  
Surgical Quality ◽  
World Data ◽  
Quality Registry

Introduction: Several clinical trials evaluating the efficacy of a carotid revascularization procedure excluded patients above age 80. In the current study, we sought to assess the differences in characteristics of octogenarians undergoing carotid endarterectomy (CEA) and carotid artery stenting (CAS) for carotid stenosis using “real-world” data from a national surgical quality registry. Methods: The National Surgical Quality Improvement Program (NSQIP) targeted datasets for CEA and CAS were queried for patients aged ≥80 years between 2012-2018. Results: We identified 5,814 patients undergoing CEA and 189 patients undergoing CAS. Patients in the CAS group were more likely to be ≥90 years (p=0.004), diabetic (p=0.04), had a history of CHF (p=0.012) and a bleeding-disorder (p<0.001). Patients in the CAS group were also more likely to have high risk anatomy (p<0.001), high-risk-physiology (p=0.028). Ninety-nine (52.4%) patients in the CAS group and 2,775 (47.7%) in the CEA group were symptomatic, with most patients in both groups presenting with an ipsilateral stroke. Among asymptomatic patients, 64 (74%) in the CAS group and 2222 (72.7%) in the CEA group had severe/total stenosis (>80%-100%) of the ipsilateral carotid, while 13(14.5%) in the CAS group and 302 (11%) in the CEA group had severe or total stenosis of contralateral carotid. Among symptomatic patients, 58(61.7%) in the CAS group and 1527 (57.5%) in the CEA group were found to have severe/total stenosis of the ipsilateral-carotid, while 12(12.8%) in the CAS group and 208(7.8%) in the CEA group were found to have severe/total occlusion of the contralateral carotid. In the carotid endarterectomy group, 12.2% (n=711) underwent CEA-alone, 44.3% (n=2,575) CEA with angioplasty, 29.9% (n=1,737) CEA with angioplasty and shunt, 2.9% (n=166) CEA with shunt and 10.7%(n=166) eversion CEA. In the CAS group, 52.4%(n=99) underwent CAS with a single tapered stent, 29.1%(n=55) CAS with single tapered stent with CPD, 11.1%(n=21) single straight stent with CPD and 1.6%(n=3) a single straight stent alone. Conclusion: These analyses from real-world data show that there may be some differences in demographic and comorbid characteristics between octogenarians undergoing CAS and CEA.

Abstract P464: Thirty Day Stroke and Mortality After Carotid Revascularization Among Octogenarians With Symptomatic Carotid Stenosis: Real-World Data Analysis From a National Surgical Quality Registry

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Mohammed Ali Alvi ◽  
Yagiz Yolcu ◽  
Kenan Rajjoub ◽  
Ozan Dikilitas
Keyword(s):  
Carotid Stenosis ◽  
Real World ◽  
Composite Outcome ◽  
Real World Data ◽  
Surgical Quality ◽  
World Data ◽  
Carotid Revascularization ◽  
Symptomatic Carotid ◽  
Quality Registry ◽  
Symptomatic Carotid Stenosis

Introduction: Due to their exclusion from most clinical trials, outcomes of carotid revascularization via a carotid endarterectomy (CEA) or carotid artery stenting (CAS) among octogenarians are not well studied. Herein, we present analysis of thirty-day stroke and mortality of patients aged ≥ 80 using real-world data from a national surgical quality registry. Methods: The National Surgical Quality Improvement Program (NSQIP) targeted dataset for CEA and CAS was queried for patients aged ≥ 80 undergoing CEA and CAS between 2012-2018. Results: A total of 94 and 2,656 patients aged ≥ 80 with symptomatic carotid stenosis undergoing CAS and CEA (respectively) were identified. Patients in the CAS group were more likely to be over 90 (p=0.006). Patients in the CAS group were more likely to have high-risk anatomy (p<0.001) and more likely to be on aspirin preoperatively (p=0.02) but less likely to have higher ASA (p<0.001). Most patients in the group presented with an ipsilateral stroke (CAS: 43.6% and CEA: 41.7%). The rate of thirty-day composite outcome (stroke or death) was found to be 5.3% in the CAS group and 4.5% in the CEA group (p=0.714) (stroke: 2.1% for CAS and 3.2% for CEA; death: 4.3% for CAS and 1.7% for CEA). Upon multivariable analysis, procedure type (CAS vs CEA) was not found to be associated with the composite-outcome (OR 1.1, 95%CI 0.43-2.82,p=0.836). Symptom presentation other than ipsilateral stroke was found to be associated with significantly decreased odds of 30-day composite outcome (amaurosis-fugax/transient monocular blindness: OR 0.42,95%CI 0.21-0.86, p=0.02; TIA: OR 0.62, 95%CI 0.42-0.93,p=0.02), while higher age was found to be associated with significantly increased odds (OR 1.512, 95%CI 1.01-2.24, p=0.02). Conclusion: Real world analysis from a surgical quality registry show that both CAS and CEA are associated with optimal 30-day outcomes among octogenarians with symptomatic carotid stenosis.

scholarly journals Renal Dysfunction is the Strongest Prognostic Factor After Carotid Artery Stenting According to Real-World Data

2022 ◽  
Vol 31 (3) ◽  
pp. 106269
Author(s):  
Shigeta Miyake ◽  
Ryosuke Suzuki ◽  
Taisuke Akimoto ◽  
Yu Iida ◽  
Wataru Shimohigoshi ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
Carotid Artery ◽  
Renal Dysfunction ◽  
Real World ◽  
Carotid Artery Stenting ◽  
Real World Data ◽  
World Data

Abstract 5: Early Outcomes After Carotid Endarterectomy Compared to Carotid Artery Stenting for Carotid Stenosis in the National Surgical Quality Improvement Program Database

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Mohammed K Alhaidar ◽  
Richard Amdur ◽  
Rami Algahtani ◽  
Dimitri Sigounas ◽  
Mohanad Algaeed ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Quality Improvement ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Carotid Artery Stenosis ◽  
Carotid Artery Stenting ◽  
Improvement Program ◽  
Surgical Quality ◽  
Procedure Type

Background: Carotid Endarterectomy (CEA) and Carotid Artery Stenting (CAS) are both viable treatment options for carotid artery stenosis. Factors including surgical risk, age, and symptomatic status are often used to help guide management decisions. Methods: We conducted a retrospective observational study using the National Surgical Quality Improvement Program (NSQIP) database to compare 30-day post-procedure outcomes including mortality, stroke, and myocardial infarction in patient with carotid stenosis undergoing CEA (n=54,640) versus CAS (n=488) from 2005 to 2012. Procedure type was identified by CPT codes. Findings: Patients undergoing CEA were more likely to be older and have symptomatic stenosis, and less likely to be white, have CHF, and have COPD. There was no significant difference between CEA and CAS in 30-day mortality (0.9% vs. 1.2%, p=0.33), stroke (1.6% vs. 1.6% p=0.93), myocardial infarction (0.9% vs. 1.6%, p=0.08), or combined outcome (3.0% vs. 4.9%, p=0.09). The interaction between symptomatic status and procedure type was not significant (p=0.29), indicating the association of symptomatic status with 30-day mortality was similar in cases receiving CEA and CAS. Conclusion: Early outcomes after CEA and CAS for carotid artery stenosis appear to be similar in a ‘real-world’ sample and comparable to clinical trials. Patients undergoing CAS were more likely to be younger and surgically higher risk based on baseline characteristics likely reflecting clinical practice case selection.

Endovascular Advances for Extracranial Carotid Stenosis

Neurosurgery ◽  
2014 ◽  
Vol 74 (suppl_1) ◽  
pp. S92-S101 ◽  
Author(s):  
Jorge L. Eller ◽  
Travis M. Dumont ◽  
Grant C. Sorkin ◽  
Maxim Mokin ◽  
Elad I. Levy ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Carotid Artery Stenosis ◽  
Carotid Artery Stenting ◽  
Carotid Stenting ◽  
Historical Background ◽  
Treatment Modalities ◽  
Endovascular Management ◽  
The Past

Abstract Carotid artery stenting has become a viable alternative to carotid endarterectomy in the management of carotid stenosis. Over the past 20 years, many trials have attempted to compare both treatment modalities and establish the indications for each one, depending on clinical and anatomic features presented by patients. Concurrently, carotid stenting techniques and devices have evolved and made endovascular management of carotid stenosis safe and effective. Among the most important innovations are devices for distal and proximal embolic protection and new stent designs. This paper reviews these advances in the endovascular management of carotid artery stenosis within the context of the historical background.

Carotid Artery Stenting in Patients with High-Risk Anatomy for Carotid Endarterectomy

2001 ◽  
Vol 8 (1) ◽  
pp. 39-43 ◽  
Author(s):  
George Dangas ◽  
John R. Laird ◽  
Roxana Mehran ◽  
Lowell F. Satler ◽  
Alexandra J. Lansky ◽  
...  
Keyword(s):  
High Risk ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Artery Stenting

scholarly journals Clinical trial of carotid artery stenting using dual-layer CASPER stent for carotid endarterectomy in patients at high and normal risk in the Japanese population

2020 ◽  
pp. neurintsurg-2020-016250
Author(s):  
Hirotoshi Imamura ◽  
Nobuyuki Sakai ◽  
Yasushi Matsumoto ◽  
Hiroshi Yamagami ◽  
Tomoaki Terada ◽  
...  
Keyword(s):  
Clinical Trial ◽  
High Risk ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Artery Stenting ◽  
Peak Systolic Velocity ◽  
Cerebrovascular Event ◽  
Performance Goal ◽  
Significant Difference ◽  
Event Rates

BackgroundThe dual-layer nitinol CASPER stent was designed to prevent plaque prolapse into its strut and periprocedural stroke.ObjectiveTo conduct a clinical trial for government approval of the device in patients at either high or normal risk for carotid endarterectomy (CEA).MethodsEligible patients had ≥50% symptomatic stenosis or ≥80% asymptomatic stenosis according to the North American Symptomatic Carotid Endarterectomy Trial methods (peak systolic velocity 130 and 230 cm/s on ultrasonography, respectively). The primary endpoint was the lack of major adverse events (MAEs), defined as death, stroke, and myocardial infarction within 30 days, and ipsilateral stroke within 1 year. The performance goal was set at 90.5%. MAE rates were also compared between the CEA high- and normal-risk groups.Results140 carotid artery stenting procedures, including 40% of patients at high risk and 60% at normal risk for CEA, were performed in 13 institutes. MAEs occurred in two cases (one intraprocedural and one postprocedural stroke), and the MAE rate was 1.4%. The non-MAE rate was 98.6% according to Kaplan-Meier analysis, which was superior to the previously set performance goal. The deployment success, target lesion revascularization (TLR), in-stent restenosis, and cerebrovascular event rates were 99.3%, 2.4%, 8.5%, and 7.2%, respectively. The MAE rate in patients with normal CEA risk was 1.2%, which was similar to the high-risk CEA group, with no significant difference due to the small number of MAEs.ConclusionsThe MAE rate following use of the CASPER stent was low (1.4%). The MAE, deployment success, TLR, in-stenosis, and cerebrovascular event rates were similar to those of previous reports.

scholarly journals 438P Real-world data of relapse after adjuvant treatment (Tx) in high-risk melanoma

2020 ◽  
Vol 31 ◽  
pp. S1412
Author(s):  
C. Ortiz Velez ◽  
G. Villacampa Javierre ◽  
E. Zamora ◽  
A. Garcia Alvarez ◽  
D.G. Illescas ◽  
...  
Keyword(s):  
High Risk ◽  
Adjuvant Treatment ◽  
Real World ◽  
Real World Data ◽  
World Data ◽  
High Risk Melanoma ◽  
Risk Melanoma
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