Comorbidities and Health-Related Quality of Life Following Revascularization for Asymptomatic Critical Internal Carotid Artery Stenosis Treated with Carotid Endarterectomy or Angioplasty with Stenting

Trystuła, Mariusz; Pąchalska, Maria

doi:10.12659/msm.916407

Cited by 8 publications

(7 citation statements)

References 82 publications

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“…The effectiveness of revascularization and postoperative complications were not related to the history of coronary artery disease of previous myocardial infarction in our cohort. This is different from the results of a study done by Trystuła and Pąchalska [ 16 ] who concluded that comorbidities of atherosclerotic vascular disease, coronary artery disease, and previous myocardial infarction had a significant influence on the effectiveness of revascularization and postoperative health-related quality of life in all patients. In our center, thorough cardiac evaluation including cardiology consultation is mandatory prior to endovascular interventions.…”

Section: Discussioncontrasting

confidence: 96%

Carotid Artery Angioplasty and Stenting for Carotid Stenosis: A Single-Center Experience from Saudi Arabia

et al. 2020

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Purpose: Atherosclerotic stenosis of the extracranial carotid artery accounts for approximately 20% of all strokes. Both carotid artery endarterectomy and carotid artery angioplasty with stenting (CAAS) are recommended for symptomatic patients with 50% or more stenosis or asymptomatic patients with 70% or more stenosis. CAAS is under-reported in Saudi Arabia, as evidenced by a thorough literature search. In this article, we aim to share our experience of CAAS to call for the necessity of conducting more research on stroke and emphasize the local need of utilizing more endovascular treatments like CAAS.Materials and Methods: A retrospective single-center observational study was conducted at King Abdulaziz Medical City in Jeddah, Saudi Arabia. The inclusion criteria consisted of all adult patients (18 years and above) with carotid stenosis who were treated with CAAS.Results: A total of 16 patients were included in the study. The mean age of the participants was 66.9±13.5 years (range 30–87 years). All patients were symptomatic (had a previous stroke or transient ischemic attack). The procedure was successful in 14 patients (87.5%), while it failed in 2 patients (12.5%) due to technical reasons. All patients had no stroke or myocardial infarction within 30 days of the procedure.Conclusion: Despite the advancement in medicine with free healthcare services in Saudi Arabia, the interventional procedures for secondary prevention of strokes are underutilized. Collaboration between different hospitals will be extremely helpful since few centers in each city are providing such treatments by an expert neurointerventionist and/or strokologist. The good selection of candidates, optimal management of comorbid conditions, and multidisciplinary care may improve outcomes and reduce mortality.

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Section: Discussioncontrasting

confidence: 96%

Carotid Artery Angioplasty and Stenting for Carotid Stenosis: A Single-Center Experience from Saudi Arabia

et al. 2020

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“…Some previous studies reported a close correlation of early PE mortality with patients' age and comorbidities [ 34 , 35 ]. The multimorbidity assessed by Charlson Comorbidity Index, which comprises among others myocardial infarction, chronic lung disease, malignancy, or renal failure, was found to be the most important prognostic factor of in-hospital death for patients with acute PE [ 35 ].…”

Section: Discussionmentioning

confidence: 93%

Continuous Aspiration Thrombectomy in High- and Intermediate-High-Risk Pulmonary Embolism in Real-World Clinical Practice

Araszkiewicz

Sławek-Szmyt

Jankiewicz

et al. 2020

Journal of Interventional Cardiology

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Objectives. We sought to assess the technical and clinical feasibility of continuous aspiration catheter-directed mechanical thrombectomy (CDT) in patients with high- or intermediate-high-risk pulmonary embolism (PE). Methods and Results. Fourteen patients (eight women and six men; age range: 29–71 years) with high- or intermediate-high-risk PE and contraindications to or ineffective systemic thrombolysis were prospectively enrolled between October 2018 and February 2020. The Indigo Mechanical Thrombectomy System (Penumbra, Inc., Alameda, California) was used as CDT device. Low-dose local thrombolysis (alteplase, 3–12 mg) was additionally applied in three patients. Technical and procedural success was achieved in 14 patients (100%). Complete or nearly complete clearance of pulmonary arteries was achieved in nine patients (64.3%), whereas partial clearance was achieved in five (35.7%). A significant improvement in the pre- and postprocedural patients’ clinical status was observed in the following fields (median; interquartile range): heart rate (110; 100–120/min vs. 85; 80–90/min; p<0.0001), systolic blood pressure (106; 90–127 mmHg vs. 123; 110–133 mmHg; p=0.049), arterial oxygen saturation (88.5; 84.2–93% vs. 95.0; 93.8–95%, p=0.0051), pulmonary artery systolic pressure (55; 44–66 mmHg vs. 42; 34–53 mmHg; p=0.0015), Miller index score (21.5; 20–23 vs. 9.5; 8–13; p<0.0001) and right ventricular/left ventricular ratio (1.3; 1.3–1.5 vs. 1.0; 0.9–1.0; p<0.0001). No major periprocedural bleeding was detected. Conclusions. CDT is a feasible and promising technique for management of high- or intermediate-high-risk PE to decrease thrombus burden, reduce right heart strain, and improve hemodynamic and clinical status. Some patients may benefit from simultaneous local low-dose thrombolytic therapy. Nevertheless, its criteria and role in CTD-managed patients require further elucidation.

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“…This was a prospective study in consecutive patients referred for potential carotid revascularization to a tertiary vascular centre performing high-volume carotid revas-cularization by means of CEA, CAS, and TCAR in patients with indications established by the multispecialty Neuro-Vascular Team and a final decision on the treatment modality incorporating the patient's informed opinion [29][30][31][32][33][34][35][36][37][38]. Referral stenosis severity had to be at least "50%" according to the modality and measurement method used by the referring centre.…”

Section: Methodsmentioning

confidence: 99%

Misclassification of carotid stenosis severity with area stenosis-based evaluation by computed tomography angiography: impact on erroneous indication to revascularization or patient (lesion) migration to a higher guideline recommendation class as per ESC/ESVS/ESO/SVS and CMS-FDA thresholds

Tekieli¹,

Mazurek²,

Dzierwa³

et al. 2022

pwki

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Intoduction Despite a growing understanding of the role played by plaque morphology, the degree of carotid lumen reduction remains the principle parameter in decisions on revascularization in symptomatic and asymptomatic patients. Computed tomography angiography (CTA) is a widely used guideline-approved imaging modality, with “percent stenosis” commonly calculated as %area reduction (area stenosis – AS). Aim We evaluated the impact of the non-linear relationship between diameter stenosis (DS) and AS (area = π • (diameter/2) 2 , so that in concentric lesions 51%AS is 30%DS and 75%AS is 50%DS) on stenosis severity misclassification using calculation of area reduction. Material and methods CTA and catheter quantitative angiography (cQA) were performed in 300 consecutive patients referred to a tertiary vascular centre for potential carotid revascularization (age: 47–83 years, 33.7% symptomatic, 36% female; referral stenosis of ≥ “50%”). CTA-AS was determined by agreement of 2 experienced radiologists; cQA-DS (pivotal trials standard reference, NASCET method) was calculated by agreement of 2 corelab analysts. Results For symptomatic lesion thresholds, CTA-AS-based calculation reclassified 76% of “< 50%” cQA-DS measurements to the “50–69%” group, and 58% of “50–69%” measurements to the “≥ 70%” group. For asymptomatic lesion thresholds, 78% of “< 60%” cQA-DS measurements were reclassified to the “60–79%” group, whereas 42% of “60–79%” cQA measurements crossed to the “≥ 80%” class. Overall, employing CTA-AS instead of cQA-DS enlarged the “60–79%” and “≥ 80%” lesion severity classes 1.6- and 5.8-fold, respectively, whereas the “≥ 70%” class increased 4.15-fold. Conclusions Replacing the pivotal carotid trials reference standard cQA-DS “%stenosis” measurement with CTA-AS-based “%stenosis” results in a large-scale lesion/patient erroneous gain of an “indication” to revascularization or migration to a higher revascularization indication class. In consequence, unnecessary carotid procedures may be performed in the absence of cQA verification. Until guidelines rectify the “%stenosis” measurement methods with different guideline-approved imaging modalities (and, where needed, re-adjust decision thresholds), CTA-AS measurement should not be used as a basis for carotid revascularization.

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Comorbidities and Health-Related Quality of Life Following Revascularization for Asymptomatic Critical Internal Carotid Artery Stenosis Treated with Carotid Endarterectomy or Angioplasty with Stenting

Cited by 8 publications

References 82 publications

Carotid Artery Angioplasty and Stenting for Carotid Stenosis: A Single-Center Experience from Saudi Arabia

Carotid Artery Angioplasty and Stenting for Carotid Stenosis: A Single-Center Experience from Saudi Arabia

Continuous Aspiration Thrombectomy in High- and Intermediate-High-Risk Pulmonary Embolism in Real-World Clinical Practice

Misclassification of carotid stenosis severity with area stenosis-based evaluation by computed tomography angiography: impact on erroneous indication to revascularization or patient (lesion) migration to a higher guideline recommendation class as per ESC/ESVS/ESO/SVS and CMS-FDA thresholds

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