scholarly journals Periprocedural complications and risk factors after carotid stenting in patients with concomitant coronary artery disease

2021 ◽  
Vol 27 (4) ◽  
pp. 72-79
Author(s):  
Georgi Goranov ◽  
Petar Nikolov
Keyword(s):  
Carotid Stenosis ◽  
Coronary Disease ◽  
Risk Groups ◽  
Carotid Stenting ◽  
Minor Stroke ◽  
Safe Procedure ◽  
Female Ratio ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis ◽  
Concomitant Coronary Artery Disease

Backgrounds and purpose: To analyse the periprocedural CAS complications in patients with concomitant coronary disease. Material and methods: A prospective study analysed the frequency and characteristics of periprocedural complications after CAS in 329 patients, of whom 62.2% had symptomatic carotid stenosis > 50% and 37.8% had asymptomatic > 70%. The mean age was 70.2 (45-88) years, male/female ratio – 253/76. The degree of carotid stenosis was assessed angiographically according to NASCET criteria and was stratified by a newly proposed carotid score in three risk groups. Distal embolic protection was used in all patients. Results: Periprocedural complications were observed in 25/349 CAS interventions: TIA – 4.9%, major stroke – 0.6%, minor stroke – 1.4%, hyperperfusion syndrome – 0.3%. No MI and death were registered. Out of more than 20 factors analysed, previous MI (χ2 = 7,707; p = 0.021) and stroke (χ2 = 9,835, p = 0.043), “slow flow” (χ2 = 3.752; p = 0.001), residual stenosis> 20% (χ2 = 13.752; p = 0.001), radiation time (F = 13.323; p = 0.000), the amount of contrast used (F = 5.297; p = 0.006), contrast- induced OBN (χ2 = 25.845; p = 0.000), females with CKD (χ2 = 8.681; p = 0.013) or with a high carotid score (χ2 = 7.329; p = 0.026) were found to be predictors of complications. Conclusion: CAS is a safe procedure with low risk of MI and death in patients with concomitant coronary disease.

Abstract 202: Cost-effectiveness Of Carotid Stenting In Canada

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Mohammed Almekhlafi ◽  
Fiona Clement ◽  
Michael D Hill
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Carotid Stenting ◽  
Cost Utility ◽  
Sensitivity Analyses ◽  
Minor Stroke ◽  
System Perspective ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis ◽  
Procedural Costs

BACKGROUND To estimate the cost-effectiveness of carotid stenting (CAS) compared to endarterectomy (CEA) in symptomatic patients. METHODS A cost-utility analysis from the Canadian health system perspective was performed using a Markov analytic model. Clinical estimates were based on a recent meta-analysis. Procedural costs for CAS and CEA were derived from a local cohort. The costs for hospitalization and rehabilitation for minor and major strokes were based on the Burden of Ischemic Stroke (BURST) study. Utility scores were based on SAPPHIRE trial. A Monte Carlo simulation using a hypothetical cohort of 10,000 and sensitivity analyses were performed to investigate the model assumptions and uncertainties. RESULTS CAS was more expensive (incremental cost of $6106.84) and had a lower effectiveness (- 0.12 QALYs). The model was sensitive to the risk of annual death. At a threshold odds ratio (OR) of 0.85, CAS was associated with an incremental cost-effectiveness ratio (ICER) of $32,839.04. Using estimates from SAPPHIRE trial, CAS dominated CEA. When estimates from CREST or EVA-3S trials were used, CEA dominated CAS. Only after simultaneously reducing CAS costs and risks of periprocedural and annual minor strokes, CAS had a favorable ICER. This was achieved at a threshold CAS procedural cost of $4350, a threshold OR of periprocedural minor stroke of 1, and a threshold OR of annual minor stroke of 1.15or less; resulting in an ICER of $577.5. The figure shows CAS cost-effectiveness plane. CONCLUSIONS In this analysis, CAS was associated with higher costs and lower effectiveness compared to CEA in symptomatic carotid stenosis patients. The results were driven by the costs of periprocedural major and minor stroke. The costs associated with MI did not impact the results. For CAS to be more effective, it needs to be performed in patients with longer survival, in patients at a high surgical-risk, or at a lower procedural costs plus lower rates of periprocedural and annual minor strokes.

Abstract WP6: Safety of Acute Carotid Stenting Treatment in Acute Symptomatic Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Darko Quispe-Orozco ◽  
Kaustubh Limaye ◽  
Cynthia Zevallos ◽  
Andrea Holcombe ◽  
Sudeepta Dandapat ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Symptom Onset ◽  
Carotid Stenting ◽  
Optimal Timing ◽  
Complication Rates ◽  
Symptomatic Carotid ◽  
Acute Group ◽  
Symptomatic Carotid Stenosis ◽  
Significant Difference ◽  
Delayed Group

Carotid stenting (CAS) has been shown to be equivalent to carotid endarterectomy in symptomatic patients; however its optimal timing remains unclear. In this study, we aim to evaluate the safety of CAS when performed within the first 48 hours of symptom onset. We performed a retrospective analysis of a prospectively collected database of consecutive CAS patients admitted to our comprehensive stroke center with TIA/stroke and ipsilateral symptomatic carotid stenosis >50% from 2014 to 2019. Medical records were retrospectively reviewed for demographic, clinical and procedural data and outcomes. Acute and delayed treatment were defined as ≤48 and >48 hours from last known well (LKW) respectively. The primary endpoint was procedure-related major complications (stroke with NIHSS increase of ≥4, myocardial infarction, parenchymal hemorrhage type 2 or death) ≤30 days after CAS. Secondary endpoints were procedure-related minor neurological (stroke with NIHSS increase of <4 and reperfusion injury) and non-neurological (groin puncture hematoma, acute anemia and arrhythmia) complications. Functional outcome was assessed by discharge and 90 days mRS, dichotomized as good (0-2) and bad (3-6). A total of 72 patients were included in the analysis, 36 in each group. There was no difference in age, NIHSS at presentation, gender, incidence of TIA as presentation or percentage of TPA received. The acute group differed significantly from the delayed group in number of thrombectomies (36.1% vs. 5.6%, p=0.001) and median time from LKW to CAS (15.9 hours vs. 88.0 hours, p<0.001). There were significantly more carotid occlusions in the acute group when compared to the delayed group (37.8% vs. 2.2, p<0.0001). Overall, the acute group did not show significant difference from the delayed group in major (2.8% vs. 5.6%, p=1.0), minor neurological (13.9% vs. 2.8%, p=0.09) and minor non-neurological complication rates (13.9% vs. 8.3%, p=0.7). Rates of good outcomes were not significantly different between the two groups at discharge (52.8% vs. 50%) or 90 days (75% vs. 63%). CAS can be performed safely in acute symptomatic carotid stenosis patients within the first 48 hours from symptom onset.

Abstract TP135: Urgent Treatment for Symptomatic Carotid Stenosis: The Pittsburgh Revascularization and Treatment Emergently After Stroke Protocol

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Daniel Tonetti ◽  
Brian Jankowitz ◽  
Kenmuir Cynthia ◽  
Benjamin Zussman ◽  
Rahul Rao ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Primary Outcome ◽  
Recurrent Stroke ◽  
Carotid Stenting ◽  
Clinical Equipoise ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis ◽  
Recorded Data ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background: Patients with symptomatic carotid stenosis remain at high risk of early recurrent stroke without revascularization. The aim of this report is to analyze prospectively-recorded data from an institutional protocol that standardized the urgent (<48 hours) treatment of patients presenting with symptomatic carotid stenosis and underwent either carotid stenting (CAS) or carotid endarterectomy (CEA). Methods: All patients presenting over 28 months to a comprehensive stroke center with symptomatic carotid stenosis within 48 hours of index event were screened for inclusion. All patients were given dual antiplatelet therapy. If there was clinical equipoise between CEA and CAS, patients underwent angiography and subsequently revascularization if DSA demonstrated ≥50% stenosis. The primary outcome was a composite of stroke or death within 30 days. Results: 178 patients with a diagnosis of recently symptomatic carotid stenosis were included; 120 patients (67%) met criteria. 59 patients underwent CEA and 61 patients underwent CAS. There were not significant differences in the primary outcome; 3 patients (5.1%) in the CEA arm and 3 patients (4.9%) in the CAS arm met the primary outcome. Conclusion: In this prospective analysis, urgent revascularization for symptomatic carotid stenosis can be done with equivalently low rates of stroke or death, regardless of revascularization strategy.

Obstructed Flow

2016 ◽  
Author(s):  
Ji Y. Chong ◽  
Michael P. Lerario
Keyword(s):  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Transient Ischemic Attack ◽  
Recurrent Stroke ◽  
Early Period ◽  
Carotid Stenting ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis ◽  
Ischemic Attack

Patients with symptomatic carotid stenosis benefit from revascularization. The risk of recurrent stroke is highest during the early period after a transient ischemic attack or stroke. Carotid endarterectomy and carotid stenting are options for treatment and should be considered within the first 2 weeks if feasible.

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