Risk of Embolization During Carotid Revascularization Procedures and The Role of Neuroimaging

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).

Download Full-text

The role of external carotid revascularization in the treatment of ocular ischemia

Journal of Vascular Surgery ◽

10.1016/0741-5214(87)90042-5 ◽

1987 ◽

Vol 6 (3) ◽

pp. 280-282 ◽

Cited By ~ 13

Author(s):

David L. Street ◽

John J. Ricotta ◽

Richard M. Green ◽

James A. DeWeese

Keyword(s):

External Carotid ◽

Carotid Revascularization

Download Full-text

Platelet Glycoprotein Receptor IIIa Polymorphism PlA1/PlA2 and Coronary Risk: a Meta-Analysis

Thrombosis and Haemostasis ◽

10.1055/s-0037-1615644 ◽

2001 ◽

Vol 85 (04) ◽

pp. 626-633 ◽

Cited By ~ 82

Author(s):

Augusto Di Castelnuovo ◽

Giovanni de Gaetano ◽

Maria Benedetta Donati ◽

Licia Iacoviello

Keyword(s):

Odds Ratio ◽

Meta Analysis ◽

Platelet Glycoprotein ◽

Published Data ◽

Coronary Risk ◽

Gene Encoding ◽

Glycoprotein Iiia ◽

Artery Disease ◽

Revascularization Procedures

SummaryMembrane glycoprotein IIb/IIIa plays a major role in platelet function. The gene encoding the glycoprotein IIIa shows a common polymorphism PlA1/PlA2 that was variably associated with vascular disease. To clarify the role of PlA1/PlA2 polymorphism in coronary risk, a meta-analysis of published data was conducted. Studies were identified both by MEDLINE searches, and hand searching of journals and abstract books.A total of 34 studies for coronary artery disease (CAD), and 6 for restenosis after revascularization were identified, for a total of 9,095 cases and 12,508 controls. In CAD, the overall odds ratio for carriers of the PlA2 allele was 1.10 (95% CI: 1.03 to 1.18), and it was 1.21 (95% CI: 1.05 to 1.38) in subjects younger than 60. Overall odds ratio was 1.31 (95% CI: 1.10 to 1.56) after revascularization procedures.The association of PlA2 status with overall cardiovascular disease in the general population is significant but weak; higher risk has been identified in less heterogeneous subgroups as in the younger cohorts and in the restenosis subset with stents.

Download Full-text

Cervical carotid revascularization: the role of angioplasty with stenting

Neurosurgery Clinics of North America ◽

10.1016/j.nec.2004.08.005 ◽

2005 ◽

Vol 16 (2) ◽

pp. 263-278 ◽

Cited By ~ 4

Author(s):

Ricardo A. Hanel ◽

Elad I. Levy ◽

Lee R. Guterman ◽

L. Nelson Hopkins

Keyword(s):

Carotid Revascularization

Download Full-text

Perioperative Neurological Evaluation and Management to Lower the Risk of Acute Stroke in Patients Undergoing Noncardiac, Nonneurological Surgery: A Scientific Statement From the American Heart Association/American Stroke Association

Circulation ◽

10.1161/cir.0000000000000968 ◽

2021 ◽

Author(s):

Curtis Benesch ◽

Laurent G. Glance ◽

Colin P. Derdeyn ◽

Lee A. Fleisher ◽

Robert G. Holloway ◽

...

Keyword(s):

Intravenous Thrombolysis ◽

Heart Association ◽

Pressure Control ◽

Neurological Dysfunction ◽

Anesthetic Technique ◽

Perioperative Stroke ◽

Carotid Revascularization ◽

Preoperative Optimization ◽

Scientific Statement

Perioperative stroke is a potentially devastating complication in patients undergoing noncardiac, nonneurological surgery. This scientific statement summarizes established risk factors for perioperative stroke, preoperative and intraoperative strategies to mitigate the risk of stroke, suggestions for postoperative assessments, and treatment approaches for minimizing permanent neurological dysfunction in patients who experience a perioperative stroke. The first section focuses on preoperative optimization, including the role of preoperative carotid revascularization in patients with high-grade carotid stenosis and delaying surgery in patients with recent strokes. The second section reviews intraoperative strategies to reduce the risk of stroke, focusing on blood pressure control, perioperative goal-directed therapy, blood transfusion, and anesthetic technique. Finally, this statement presents strategies for the evaluation and treatment of patients with suspected postoperative strokes and, in particular, highlights the value of rapid recognition of strokes and the early use of intravenous thrombolysis and mechanical embolectomy in appropriate patients.

Download Full-text

Trends in Carotid Revascularization Procedures

JAMA ◽

10.1001/jama.2017.19773 ◽

2018 ◽

Vol 319 (3) ◽

pp. 307

Author(s):

Mohamad A. Hussain ◽

Deepak L. Bhatt ◽

Mohammed Al-Omran

Keyword(s):

Carotid Revascularization ◽

Revascularization Procedures

Download Full-text

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

Stroke ◽

10.1161/str.51.suppl_1.wp167 ◽

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.

Download Full-text

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

Stroke ◽

10.1161/str.45.suppl_1.wp304 ◽

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.

Download Full-text