scholarly journals Hemodynamic Depression of Early Carotid Revascularization on Ischemic Stroke Patients with Symptomatic Carotid Stenosis

2017 ◽  
Vol 10 (2) ◽  
pp. 92-98
Author(s):  
Jun Woo Kim ◽  
Youngrok Do
Keyword(s):  
Ischemic Stroke ◽  
Carotid Stenosis ◽  
Stroke Patients ◽  
Carotid Revascularization ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis

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.

Abstract P566: Identifying Sex-Specific Differences in the Carotid Revascularization Literature: Findings From a Scoping Review

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Vignan Yogendrakumar ◽  
Michel C Shamy ◽  
Brian Dewar ◽  
Dean Fergusson ◽  
Dar Dowlatshahi ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Medical Therapy ◽  
Scoping Review ◽  
Sufficient Information ◽  
Significant Heterogeneity ◽  
Long Term Outcomes ◽  
Carotid Revascularization ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis

Background and Purpose: No systematic review of the literature has dedicated itself to looking at the management of symptomatic carotid stenosis in women. In this scoping review, we aimed to identify all randomized controlled trials (RCTs) that reported sex-specific outcomes for patients who underwent carotid revascularization, and determine whether sufficient information is reported within these studies to assess women’s short and long-term outcomes. Methods: We systematically searched Medline, Embase, Pubmed, and Cochrane libraries for RCTs published between 1991 and 2020 that included women and compared either endarterectomy with stenting, or any revascularization (endarterectomy or stenting) with medical therapy in patients with symptomatic high grade (greater than 50%) carotid stenosis. Results: From 1,537 references examined, 27 eligible studies were identified. Sex-specific outcomes were reported in 13 studies. Baseline patient characteristics of enrolled women were reported in 2 of those 13 studies. Common outcomes reported included stroke and death, however there was significant heterogeneity in the reporting of both periprocedural and long-term outcomes. Sex-specific differences relating to the degree of stenosis and time from index event to treatment were limited to studies comparing endarterectomy to medical therapy. Adverse events were not reported by sex. Conclusions: Half of the previously published RCTs and systematic reviews report sex-specific outcomes. Detailed analysis on the benefits of carotid artery intervention for women with symptomatic stenosis is limited . Further analysis with individual patient data and a network meta-analysis is the necessary next step to better assess the treatment effects of carotid management in women.

Timing of Carotid Endarterectomy for Symptomatic Carotid Stenosis: A Snapshot of Current Trends and Systematic Review of Literature on Changing Paradigm towards Early Surgery

Neurosurgery ◽  
2019 ◽  
Vol 85 (2) ◽  
pp. E214-E225 ◽  
Author(s):  
Amey R Savardekar ◽  
Vinayak Narayan ◽  
Devi P Patra ◽  
Robert F Spetzler ◽  
Hai Sun
Keyword(s):  
Systematic Review ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Current Literature ◽  
Meta Analysis ◽  
Review Of Literature ◽  
Carotid Revascularization ◽  
Symptomatic Carotid ◽  
Index Event ◽  
Symptomatic Carotid Stenosis

Abstract Carotid revascularization has been recommended as the maximally beneficial treatment for stroke prevention in patients with recently symptomatic carotid stenosis (SCS). The appropriate timing for performing carotid endarterectomy (CEA) within the first 14 d after the occurrence of the index event remains controversial. We aim to provide a snapshot of the pertinent current literature related to the timing of CEA for patients with SCS. A systematic review of literature was conducted to study the timing of CEA for SCS. The guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) were followed. A total of 63 articles were identified as relevant to this topic. A summary of 15 articles favoring urgent CEA (within 48 h) for SCS within 48 h of index event and 9 articles not favoring urgent CEA is presented. A consensus is still to be achieved on the ideal timing of CEA for SCS within the 14-d window presently prescribed. The current literature suggests that patients who undergo urgent CEA (within 48 h) after nondisabling stroke as the index event have an increased periprocedural risk as compared to those who had transient ischemic attack (TIA) as the index event. Further prospective studies and clinical trials studying this question with separate groups classified as per the index event are required to shed more light on the subject. The current literature points to a changing paradigm towards early carotid surgery, specifically targeted within 48 h if the index event is TIA, and within 7 d if the index event is stroke.

Early carotid endarterectomy in patients with symptomatic carotid stenosis in the acute period of ischemic stroke

2018 ◽  
Vol 118 (9) ◽  
pp. 49
Author(s):  
S. Sh. Zabirov ◽  
P. V. Chechulov ◽  
I. A. Voznyuk ◽  
A. V. Polyakova ◽  
A. V. Solovyev ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Acute Period ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis
Sign in / Sign up

Export Citation Format

Share Document