scholarly journals Carotid Interventions for Women: The Hazards and Benefits

Stroke ◽  
2022 ◽  
Author(s):  
Caron Rockman ◽  
Valeria Caso ◽  
Peter A. Schneider
Keyword(s):  
Small Diameter ◽  
Plaque Morphology ◽  
Revascularization Procedure ◽  
Careful Evaluation ◽  
Men And Women ◽  
Carotid Revascularization ◽  
Female Patients ◽  
Current Review ◽  
Revascularization Procedures ◽  
Similar Risk

The goal of the current review is to examine the hazards and benefits of carotid interventions in women and to provide recommendations for the indications for carotid intervention in female patients. Stroke and cerebrovascular disease are prevalent in women. There are inherent biological and other differences in men and women, which affect the manifestations and outcome of stroke, with women experiencing worse disability and higher mortality following ischemic stroke than men. Due to the underrepresentation of female patients in most clinical trials, the ability to make firm but alternative recommendations for women specifically on the management of carotid stenosis is challenging. Although some data suggest that women might have worse periprocedural outcomes as compared to men following all carotid revascularization procedures, there is also an abundance of data to support a similar risk for carotid procedures in men and women, especially with carotid endarterectomy and transcarotid artery revascularization. Therefore, the indications for carotid revascularization are the same in women as they are in men. The choice of a carotid revascularization procedure in women is based upon the same factors as in men and requires careful evaluation of a particular patient’s risk profile, anatomic criteria, plaque morphology, and medical comorbidities that might favor one technique over the other. When performing carotid revascularization procedures in women, tailored techniques and procedures to address the small diameter of the female artery are warranted.

Cerebral vasoconstriction following CEA and the role of conventional cerebral angiography

2020 ◽  
pp. 10.1212/CPJ.0000000000000941
Author(s):  
Azam S. Tolla ◽  
Muhammad U. Farooq ◽  
Bradly Haveman-Gould ◽  
Ghassan Naisan ◽  
Philip B. Gorelick
Keyword(s):  
Myocardial Infarction ◽  
Carotid Artery ◽  
Cerebral Hyperperfusion Syndrome ◽  
Carotid Revascularization ◽  
Cerebral Vasoconstriction ◽  
Cerebral Hyperperfusion ◽  
Delayed Complication ◽  
Reduce Risk ◽  
Revascularization Procedures

Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are established cerebrovascular procedures to reduce risk of stroke. Complications include stroke, myocardial infarction, and death. A delayed complication following carotid revascularization is cerebral hyperperfusion syndrome (CHS), which can manifest as intracerebral hemorrhage (ICH)[1]. A less common delayed complication of carotid revascularization procedures is reversible cerebral vasoconstriction syndrome (RCVS).

Trends in Carotid Revascularization Procedures

JAMA ◽  
2018 ◽  
Vol 319 (3) ◽  
pp. 307
Author(s):  
Mohamad A. Hussain ◽  
Deepak L. Bhatt ◽  
Mohammed Al-Omran
Keyword(s):  
Carotid Revascularization ◽  
Revascularization Procedures

Abstract WP167: Changing Face of Carotid Revascularization Procedures in the United States

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Saqib A Chaudhry ◽  
Iqra N Akhtar ◽  
Wei Huang ◽  
Ameer E Hassan ◽  
Mohammad Rauf A Chaudhry ◽  
...  
Keyword(s):  
United States ◽  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
The United States ◽  
Artery Stenosis ◽  
Teaching Hospitals ◽  
Trend Test ◽  
Carotid Revascularization ◽  
Asymptomatic Patients ◽  
Revascularization Procedures

Background: Carotid revascularization procedure, carotid endarterectomy (CEA) and carotid stent placement (CAS), are some of the most common procedures performed in United States and expected to change due to wider adoption of CAS. We performed this study to determine the changes in utilization of CEA and CAS in United States using nationally representative data. Methods: We used the National Inpatient Sample (NIS) from 2005 to 2014 to assess the changes in utilization of CEA and CAS over last 10 years in patients with symptomatic and asymptomatic carotid artery stenosis. NIS is the largest all payer dataset that includes diagnoses, admissions and discharge, demographics, and outcomes data of patients admitted to short stay non-Federal hospitals in the United States. We analyzed patterns of changes in utilization in various subsets of patients with carotid artery stenosis. Results: A total of 1,186,182 patients underwent carotid revascularization procedures during study period; 1,032,148 (87.1%) and 154,035 (12.9%) were CEA and CAS, respectively. The overall carotid revascularization procedures decreased over last 10 years (11.1% in 2005 to 8.4%in 2014, trend test p <.0001). Carotid revascularization in symptomatic patients increased (7.64% in 2005 to 11.01% in 2014, trend test p <.0001) while it decreased in asymptomatic patients (92.36% in 2006 to 88.99% in 2014, trend test p <.0001). There was an overall decrease in CEA (11.6% in 2005 to 8.3% in 2014, trend test <.0001) while in CAS remained unchanged (8.1% in 2005 to 8.9% in 2014, p=NS). There was an increase in carotid revascularization in teaching hospitals (40.9% in 2005 to 67.1% in 2014, trend test p <.0001) while decrease in non-teaching hospitals (50.9% in 2006 to 27.1% in 2014, trend test p <.0001). There was a decrease in carotid revascularization procedures in patients aged ≥80 years (19.8% in 2005 to 18.7% in 2014, trend test p <.0001) and CEA (19.6% in 2006 to 18.8% in 2014, trend test P<.0001) and CAS (21.2% in 2006 to 18.6% in 2014, trend test p=<.0001). Conclusion: Although CAS is increasing in a disproportionate manner within patient subgroups in United States, overall carotid revascularization procedures have decreased for unclear reasons.

Abstract W P304: Variation in Use of Carotid Revascularization Procedures and In-Hospital Mortality Among Large, Urban Teaching Hospitals in the United States

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Judith H Lichtman ◽  
Erica C Leifheit-Limson ◽  
Yun Wang ◽  
Virginia J Howard ◽  
Larry B Goldstein
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
The United States ◽  
System Level ◽  
Teaching Hospitals ◽  
Future Research ◽  
Urban Teaching ◽  
Carotid Revascularization ◽  
Hospital Variation ◽  
Revascularization Procedures

Background: Guidelines and quality improvement efforts seek to minimize variation in care and outcomes across hospitals. We assessed hospital-level variation in procedure rates and in-hospital mortality for patients hospitalized with ischemic stroke at similar hospitals in the US. The use of procedures and in-hospital mortality were not expected to vary significantly among comparable, high-volume facilities after adjusting for patient case-mix. Methods: We selected urban teaching hospitals with ≥100 annual ischemic stroke discharges (ICD-9 433, 434, 436) from the Nationwide Inpatient Sample 2010-2011. Generalized linear mixed models were used to quantify between-hospital variation in the use of carotid artery stenting (CAS) and endarterectomy (CEA), as well as in-hospital mortality, adjusting for patient characteristics. Adjusted odds ratios were calculated to reflect the odds that patients would have the procedure/outcome when treated at hospitals 1 SD above relative to hospitals 1 SD below the overall rate for that procedure/outcome (an odds ratio of 1.0 would reflect no hospital variation in the procedure/outcome). Results: A total of 105 urban teaching hospitals were selected, with a median annual volume of 453 ischemic stroke discharges (IQR 351-600). Among a total of 52,090 ischemic stroke discharges (mean age 68±14.8 yrs), the overall rates were 3.7% (SD 3.1) for CAS and 15.6% (SD 8.0) for CEA; in-hospital mortality was 4.3% (SD 1.7). The odds of receiving CAS and CEA were almost 7 and 4 times as high, respectively, for a patient treated at a hospital 1 SD above versus 1 SD below the overall rate for that procedure (CAS: 6.68, 95% CI 4.97-8.98; CEA: 3.62, 95% CI 3.17-4.13). The odds of dying for those treated at a hospital 1 SD above relative to 1 SD below the overall mortality rate were 2.09 (95% CI 1.98-2.21). Conclusions: There was marked between-hospital heterogeneity in the use of carotid revascularization procedures and in-hospital mortality among large, urban US teaching hospitals. Future research needs to identify system-level factors contributing to these variations in care and outcomes.

Socioeconomic Disparities in Carotid Revascularization Procedures

2020 ◽  
Vol 34 (7) ◽  
pp. 1836-1845
Author(s):  
Latha Panchap ◽  
Seyed A. Safavynia ◽  
Virginia Tangel ◽  
Robert S. White
Keyword(s):  
Socioeconomic Disparities ◽  
Carotid Revascularization ◽  
Revascularization Procedures

scholarly journals Lower carotid revascularization rates after stroke in racial/ethnic minority-serving US hospitals

Neurology ◽  
2019 ◽  
Vol 92 (23) ◽  
pp. e2653-e2660 ◽  
Author(s):  
Roland Faigle ◽  
Lisa A. Cooper ◽  
Rebecca F. Gottesman
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Predominantly White ◽  
Ethnic Minority ◽  
System Level ◽  
Carotid Revascularization ◽  
Logistic Regression Models ◽  
Race Disparities ◽  
Revascularization Procedures ◽  
Racial Ethnic

ObjectiveWe sought to determine whether the use of carotid revascularization procedures after stroke due to carotid stenosis differs between minority-serving hospitals and hospitals serving predominantly white patients.MethodsWe identified ischemic stroke cases due to carotid disease, identified by ICD-9-CM codes, from 2007 to 2011 in the Nationwide Inpatient Sample. The use of carotid endarterectomy (CEA) and carotid artery stenting (CAS) was recorded. Hospitals with ≥40% racial/ethnic minority patients (minority-serving hospitals) were compared to hospitals with <40% minority patients (predominantly white hospitals [hereafter, abbreviated to white]). Logistic regression was used to evaluate the use of CEA/CAS among minority-serving and white hospitals.ResultsOf the 26,189 ischemic stroke cases meeting inclusion criteria, 20,870 (79.7%) were treated at 1,113 white hospitals and 5,319 (20.3%) received care at 325 minority-serving hospitals. Compared to patients in white hospitals, patients in minority-serving hospitals were less likely to undergo CEA/CAS (17.6%, 95% confidence interval [CI] 16.6%–18.6%, in minority-serving vs 21.2%, 95% CI 20.7%–21.8%, in white hospitals; p < 0.001). In fully adjusted logistic regression models, the odds of CEA/CAS were lower in minority-serving compared to white hospitals (odds ratio 0.81, 95% CI 0.70–0.93), independent of individual patient race/ethnicity and other measured hospital characteristics. White and Hispanic individuals had significantly lower odds of CEA/CAS in minority-serving compared to white hospitals. Patient-level racial/ethnic differences in the use of carotid revascularization procedures remained within each hospital stratum.ConclusionThe odds of carotid revascularization after stroke is lower in minority- compared to white-serving hospitals, suggesting system-level factors as a major contributor to explain race disparities in the use of carotid revascularization.

scholarly journals Medicare Age-Stratified Comparative Effectiveness of Carotid Revascularization Procedures: A National Evaluation

2012 ◽  
Vol 56 (4) ◽  
pp. 1189
Author(s):  
Jeffrey Jim ◽  
Pamela L. Owens ◽  
Patrick J. Geraghty ◽  
Luis A. Sanchez ◽  
Brian G. Rubin
Keyword(s):  
Comparative Effectiveness ◽  
Carotid Revascularization ◽  
Revascularization Procedures

Wire escalation in emergent revascularization procedures of internal carotid artery occlusions: the use of high tip stiffness microguidewires

2017 ◽  
Vol 9 (6) ◽  
pp. 547-552 ◽  
Author(s):  
José E Cohen ◽  
Ronen R Leker ◽  
John M Gomori ◽  
Eyal Itshayek
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Revascularization Procedure ◽  
Inclusion Criteria ◽  
Successful Performance ◽  
Endovascular Revascularization ◽  
Angiographic Evidence ◽  
Total Coronary Occlusions ◽  
Revascularization Procedures

ObjectiveWe examined the usefulness and safety of high tip stiffness cardiac microguidewires in the endovascular revascularization of selected cases of internal carotid artery (ICA) occlusion.MethodsFiles of patients with acute ischemic symptoms due to ICA occlusions managed from August 2010 to August 2016 by urgent endovascular revascularization were retrospectively reviewed with a waiver of informed consent. Cases where there was escalation to stiff tipped cardiovascular microguidewires after at least two failed attempts to cross the carotid occlusion with standard neuro-microguidewires were included. Radiological and interventional data were recorded.Results63 patients with acute carotid occlusions underwent emergent endovascular revascularization in the study period; 5/63 patients met the inclusion criteria. In 4/5 patients, there was no angiographic evidence of the remnant origin of the ICA; in 1/5 there was a wide round shaped proximal calcified cap that precluded soft guidewire entry. In all cases, antegrade wiring was achieved only after switching to stiffer guidewires designed for the management of chronic cardiac occlusions. The use of these stiffer tip wires was considered of critical importance in achieving the successful performance of the ICA revascularization procedure. In all patients, revascularization was achieved, and 90 day modified Rankin Scale score ranged from 0 to 2.ConclusionsWhen regular neuro-guidewires do not allow antegrade wiring in cases of ICA occlusion, wire escalation to high tip stiffness guidewires may improve success. These wires, designed to deal with chronic total coronary occlusions, can serve as a platform for new neuro-guidewires to be used in the challenging field of resistant supra-aortic occlusions.

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