Body mass index and outcome after revascularization for symptomatic carotid artery stenosis

Volkers, Eline J.; Greving, Jacoba P.; Hendrikse, Jeroen; Algra, Ale; Kappelle, L. Jaap; Becquemin, J. P.; Bonati, Leo H.; Brott, Thomas G.; Calvet, D.; Eckstein, H.‐H.; Fraedrich, Gustav; Gregson, John; Halliday, Alison; Howard, George; Jansen, Olav; Roubin, Gary S.; Brown, Martin M.; Mas, Jean Louis; Ringleb, Peter A.

doi:10.1212/wnl.0000000000003957

Cited by 19 publications

(14 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Thirty day death/stroke remained significantly higher when CAS was performed 8e14 days after symptom onset (8.1%) vs. 3.4% after CEA (OR 2.42, 95% CI 1.0e5.7; p ¼ .04) 114. A second meta-analysis (n ¼ 138) included symptomatic CREST patients 119. Thirty day death/stroke after CAS less than seven days after symptom onset was 8.4% vs. 1.3% after CEA (OR 6.51, 95% CI 2.0e21.21; p ¼ .002).…”

mentioning

confidence: 99%

Editor's Choice – Overview of Primary and Secondary Analyses From 20 Randomised Controlled Trials Comparing Carotid Artery Stenting With Carotid Endarterectomy

Batchelder

Saratzis

Naylor

2019

European Journal of Vascular and Endovascular Surgery

View full text Add to dashboard Cite

This paper provides an overview of primary/secondary outcome data from 20 randomised controlled trials comparing carotid endarterectomy (CEA) with carotid artery stenting (CAS) in symptomatic and asymptomatic patients, including meta-analyses for peri-operative risks and late ipsilateral stroke. Secondary analyses include (i) risk factors for stroke after CEA/CAS; (ii) the effect of peri-operative stroke or myocardial infarction on long term survival; (iii) non-stroke complications; (iv) the significance of new white matter lesions on late stroke and cognitive impairment; and (v) whether asymptomatic 70%e99% restenoses increase the risk of ipsilateral stroke after CEA and CAS. Objectives: The aim of this review was to carry out primary and secondary analyses of 20 randomised controlled trials (RCTs) comparing carotid endarterectomy (CEA) with carotid artery stenting (CAS). Methods: A systematic review and meta-analysis of data from 20 RCTs (126 publications) was carried out. Results: Compared with CEA, the 30 day death/stroke rate was significantly higher after CAS in seven RCTs involving 3467 asymptomatic patients (odds ratio [OR] 1.64, 95% confidence interval [CI] 1.02e2.64) and in 10 RCTs involving 5797 symptomatic patients (OR 1.71, 95% CI 1.38e2.11). Excluding procedural risks, late ipsilateral stroke was about 4% at 9 years for both CEA and CAS, i.e., CAS was durable. Reducing procedural death/stroke after CAS may be achieved through better case selection, e.g., performing CEA in (i) symptomatic patients aged > 70 years; (ii) interventions within 14 days of symptom onset; and (iii) situations where stroke risk after CAS is predicted to be higher (segmental/remote plaques, plaque length > 13 mm, heavy burden of white matter lesions [WMLs], where two or more stents might be needed). New WMLs were significantly more common after CAS (52% vs. 17%) and were associated with higher rates of late stroke/transient ischaemic attack (23% vs. 9%), but there was no evidence that new WMLs predisposed towards late cognitive impairment. Restenoses were more common after CAS (10%) but did not increase late ipsilateral stroke. Restenoses (70%e99%) after CEA were associated with a small but significant increase in late ipsilateral stroke (OR 3.87, 95% CI 1.96e7.67; p < .001). Conclusions: CAS confers higher rates of 30 day death/stroke than CEA. After 30 days, ipsilateral stroke is virtually identical for CEA and CAS. Key issues to be resolved include the following: (i) Will newer stent technologies and improved cerebral protection allow CAS to be performed < 14 days after symptom onset with risks similar to CEA? (ii) What is the optimal volume of CAS procedures to maintain competency? (iii) How to deliver better risk factor control and best medical treatment? (iv) Is there a role for CEA/CAS in preventing/reversing cognitive impairment?

show abstract

mentioning

confidence: 99%

Editor's Choice – Overview of Primary and Secondary Analyses From 20 Randomised Controlled Trials Comparing Carotid Artery Stenting With Carotid Endarterectomy

Batchelder

Saratzis

Naylor

2019

European Journal of Vascular and Endovascular Surgery

View full text Add to dashboard Cite

show abstract

“…Fourth, the assessment of the relationship between volume and outcome is hampered since not all studies adjusted for characteristics that are known to influence outcome following carotid revascularization (Appendix Tables 5-6). 6,63–65…”

Section: Discussionmentioning

confidence: 99%

High Operator and Hospital Volume Are Associated With a Decreased Risk of Death and Stroke After Carotid Revascularization

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

“…18 In the patients accepting carotid artery stenting or carotid endarterectomy for symptomatic carotid artery stenosis, BMI is not a periprocedural risk of stroke or death; however, overweight patients were associated with lower post procedural risk than that in normal weight group. 19 Obesity was associated with lower risks in cardiac surgery, as showing a "U-shape" association between mortality and BMI classes which was observed in the cohort study including 557,720 patients. 20 Study showed that BMI ≥40.0 was an independent risk factor for longer length of stay.…”

Section: Obesity and T2dmentioning

confidence: 70%

Which BMI for Diabetes Patients is Better? From the View of the Adipose Tissue Macrophage-Derived Exosome

Liu¹,

H²,

Y³

et al. 2022

DMSO

View full text Add to dashboard Cite

Diabetes, as a group of metabolic diseases, can elevate blood glucose, thus leading to the development of life-threatening complications. It is difficult to define the outcome for diabetics with different BMI. This review will illustrate the adipose tissue macrophagederived exosome in the diabetics with different BMI. Patients and Methods: Insulin resistance in peripheral tissues can cause diabetes. The peripheral tissues include liver, muscle, or the adipose depots. Communication between these organs is fatal to the maintenance of glucose homeostasis. This review will illustrate this communication. Obesity is closely linked with diabetes. There are different changes in fat distribution in diabetic patients. Adipose tissue macrophages can secrete various hormones, including adiponectin, leptin, resistin and other classical cytokines, such as TNF-α and IL-6. Studies illustrated that exosomes from the adipose tissue, can modulate inter-organ cross-talk by regulating gene expression in other tissues. Results: Adipose tissue macrophages exosomes links thin and fat individuals in the development of diabetes. Conclusion:The molecular pathways initiated by exosomes such as miRNA in the situations of metabolic stress could help us gain a deeper knowledge of the pathophysiology of diabetes.

show abstract

Body mass index and outcome after revascularization for symptomatic carotid artery stenosis

Abstract: BMI is not associated with periprocedural risk of stroke or death; however, BMI 25-<30 is associated with lower postprocedural risk than BMI 20-<25. These observations were similar for CAS and CEA.

Cited by 19 publications

References 30 publications

Editor's Choice – Overview of Primary and Secondary Analyses From 20 Randomised Controlled Trials Comparing Carotid Artery Stenting With Carotid Endarterectomy

Editor's Choice – Overview of Primary and Secondary Analyses From 20 Randomised Controlled Trials Comparing Carotid Artery Stenting With Carotid Endarterectomy

High Operator and Hospital Volume Are Associated With a Decreased Risk of Death and Stroke After Carotid Revascularization

Which BMI for Diabetes Patients is Better? From the View of the Adipose Tissue Macrophage-Derived Exosome

Contact Info

Product

Resources

About