Do Men and Women Undergoing Carotid Endarterectomy or Carotid Stent Placement in General Practice Have Different Outcomes (P06.203)

Background: Atrial fibrillation (AF) is a relatively common comorbid condition among patients who undergo carotid endarterectomy (CEA) and carotid artery stent placement (CAS); however the outcomes of patients with AF undergoing CAS have not been fully examined. We sought to investigate the impact of AF on in-hospital outcomes of CEA and CAS in general practice. Methods: We analyzed the data from the Nationwide Inpatient Sample (NIS), which is representative of all admissions in the United States from 2005 to 2009. The primary end point was postoperative stroke, cardiac complications, postoperative mortality, and composite of these endpoints. Multivariate regression analysis was performed to determine the 1/. the association of AF (compared to without AF); and 2/. the association of CEA (compared with CAS) with the occurrence of postoperative stroke, cardiac complication or death. Covariates included in the logistic regression were patient’s gender, age, ethnicity, comorbid conditions, symptom status (symptomatic vs asymptomatic status), and hospital characteristics. Results: Of the total 672,074 patients who underwent CAS or CEA, 8.8% of the procedures were performed in patients with AF. For patients undergoing CEA, AF was associated with an increased risk of postoperative stroke (P<0.0001; OR, 1.57: 95% CI, 1.32-1.86) but not in patients undergoing CAS. The relative risk of composite endpoint of postoperative stroke, cardiac complications, and mortality was increased in patients with AF undergoing CAS (OR 1.43, 95% CI 1.18-1.74) and those undergoing CEA (OR 3.18, 95% CI 2.89-3.49). After adjustment for potential confounders, the odds of composite endpoint of postoperative stroke, cardiac complications, and mortality (OR, 1.31, 95% CI 1.08 - 1.59) were significantly higher among patients who underwent CEA (compared with those who underwent CAS). An inverse relationship was seen in patients without AF in whom the composite endpoint was significantly lower in patients undergoing CEA. Conclusion: Our analysis suggests that almost 10% of CAS and CEA are performed in patients with AF in general practice, and higher rates of adverse events are observed among these patients particularly those undergoing CEA.

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The effect of atrial fibrillation on outcomes in patients undergoing carotid endarterectomy or stent placement in general practice

Journal of Vascular Surgery ◽

10.1016/j.jvs.2014.11.001 ◽

2015 ◽

Vol 61 (4) ◽

pp. 927-932 ◽

Cited By ~ 15

Author(s):

Masaki Watanabe ◽

Saqib A. Chaudhry ◽

Malik Muhammad Adil ◽

Syeda Laila Alqadri ◽

Shahram Majidi ◽

...

Keyword(s):

Atrial Fibrillation ◽

General Practice ◽

Carotid Endarterectomy ◽

Stent Placement

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Carotid Plaque Characterization Using Digital Image Processing and its Potential in Future Studies of Carotid Endarterectomy and Angioplasty

Journal of Endovascular Therapy ◽

10.1177/152660289800500309 ◽

1998 ◽

Vol 5 (3) ◽

pp. 240-246 ◽

Cited By ~ 9

Author(s):

Giorgio M. Biasi ◽

Paolo M. Mingazzini ◽

Lucia Baronio ◽

Maria Rosa Piglionica ◽

Stefano A. Ferrari ◽

...

Keyword(s):

Cerebral Infarction ◽

Carotid Endarterectomy ◽

Carotid Plaque ◽

Screening Tool ◽

Brain Infarction ◽

Carotid Stent ◽

Plaque Characterization ◽

Duplex Scan ◽

Future Studies ◽

The Mean

Purpose: To corroborate the validity of a computerized methodology for evaluating carotid lesions at risk for stroke based on plaque echogenicity. Methods: The records of 96 carotid endarterectomy patients (59 men; median age 69.5 years, range 52 to 83) with stenoses > 50% were studied retrospectively. Forty-one patients (43%) had been symptomatic preoperatively. All patients had undergone computed tomography (CT) to detect infarction in the carotid territory and a duplex scan to measure carotid stenosis. Plaque echogenicity was analyzed by computer, expressing the echodensity in terms of the gray scale median (GSM). The incidence of CT-documented cerebral infarction was analyzed in relation to symptomatology, percent stenosis, and echodensity. Results: Symptoms correlated well with CT evidence of brain infarction: 32% of symptomatic patients had a positive CT scan versus 16% for asymptomatic plaques (p = 0.076). The mean GSM value was 56 ± 14 for plaques associated with negative CT scans and 38 ± 13 for plaques from patients with positive scans (p < 0.0001). However, there was no difference in the GSM value between plaques with > or < 70% stenosis. Furthermore, the incidence of CT infarction was 40% in the cerebral territory of carotid plaques with a GSM value < 50 and only 9% in those with a GSM > 50 (p < 0.001). Conclusions: Computerized analysis of plaque echogenicity appears to provide clinically useful data that correlates with the incidence of cerebral infarction and symptoms. This method of analyzing plaque echolucency could be used as a screening tool for carotid stent studies to identify high-risk lesions better suited to conventional surgical treatment.

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Abstract P426: Platelet Glycoprotein IIb/IIIa Inhibitors as an Adjunct to Stent Placement of Carotid Stenosis in Symptomatic Patients

Stroke ◽

10.1161/str.52.suppl_1.p426 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Sachin M Bhagavan ◽

Ammad Ishfaq ◽

Muhammad F Ishfaq ◽

Mukaish Kumar ◽

Shruthi Pulimamidi ◽

...

Keyword(s):

Ischemic Stroke ◽

Hospital Mortality ◽

Carotid Stenosis ◽

Transient Ischemic Attack ◽

Stent Placement ◽

Severe Disability ◽

Platelet Glycoprotein ◽

Carotid Stent ◽

Significant Difference ◽

Ischemic Attack

Background: Intra-arterial or intravenous platelet glycoprotein (GP) IIb/IIIa inhibitors have been used as adjunct to stent placement of carotid stenosis in patients with ischemic stroke or transient ischemic attack. Objective: To determine the proportion of patients with ischemic stroke or transient ischemic attack who received platelet GP IIb/IIIa inhibitors as adjunct to carotid stent placement and associated outcomes. Methods: We analyzed data from Cerner Health Facts® which collected data from participating facilities from January 1, 2000 to July 1, 2018. We identified patients with ischemic stroke or transient ischemic attack who underwent carotid stent placement for carotid stenosis and received Abciximab, Eptifibatide, or Tirofiban. Outcome was defined by discharge destination and classified into none to minimal disability, moderate to severe disability, or death. Results: A total of 8.4 % of 4567 patients with ischemic stroke or transient ischemic attack who underwent carotid stent placement for carotid stenosis received platelet GP IIb/IIIa inhibitors. Patients who received platelet GP IIb/IIIa inhibitors were more likely to experience cerebral ischemia (14.8% versus 7.5%) and undergo intubation/mechanical ventilation (4.4% versus 2%). There was a significant difference between patients who did or did not receive platelet GP IIb/IIIa inhibitors in terms of in hospital mortality rates (2.7% versus 1.2%, p=0.0152), none to mild disability (67.3% vs 75.7%, p=0.0003), and moderate to severe disability (30.1% vs 23.1%,p=0.0024). Conclusions: Adjunct use of platelet GP IIb/IIIa inhibitors in patients undergoing carotid stent placement for symptomatic carotid stenosis was associated with increased rates of in hospital mortality and moderate to severe disability.

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