Comparison of Long Term Prognosis between Carotid Endarterectomy versus Stenting; A Korean Population-Based Study Using National Insurance Data

Seo, Kwon‐Duk; Lee, Ki Young; Suh, Sang Hyun

doi:10.5469/neuroint.2019.00115

Cited by 7 publications

(10 citation statements)

References 22 publications

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“…Stent technology has been gradually widely developed in recent years, and the upgrading of materials, technologies and concepts has reduced the complications to an acceptable range. New clinical trials have shown that CEA and CAS have no signi cant difference in the incidence of surgical complications and long-term prognosis of patients [35][36][37][38][39], and more clinical trials are needed in the later stage to support the more widespread application of stent technology, in order to further explore the surgical indications of these two [40].…”

Section: Discussionmentioning

confidence: 99%

HDL can predict the treatment of hypotension after CAS surgery for initial internal carotid artery stenosis

Ma,

Yang,

et al. 2024

Preprint

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Background Ischemic stroke ranks at the forefront of the global spectrum of causes of death. Internal carotid artery stenosis is one of the causes of ischemic stroke, and CAS is an important method to treat internal carotid artery stenosis. However, postoperative hypotension and other complications can lead to serious neurological defects. Methods The clinical data and imaging data of patients with internal carotid artery stenosis treated by stenting in the Department of Neurology of the Second Affiliated Hospital of Xinjiang Medical University from January 2021 to December 2023 were collected for statistical analysis. Results A total of 23 patients were enrolled, 87% were male, the median age of onset was 65 years (IQR, 57-71 years), 56.2% had a history of smoking, 82.6% had hypertension, 78.9% had poor blood pressure control, 47.8% had a chronic disease, 81.8% of whom were hypertensive. Before admission, 74% of the patients had transient or persistent neurological impairment, that is TIA or IS at any stage. Of the 46 internal carotid arteries in 23 patients, 25 (54.3%) had severe stenosis, 60.9% had bilateral stenosis, and 85.7% mainly had bi-focal or severe and moderate stenosis on one side. 60.9% developed postoperative hypotension, of which 57.1% were treated with vasoactive drugs. Only HDL levels were different in the three groups with normal blood pressure, rehydration after hypotension, and medication after hypotension. Conclusions HDL level does not predict whether blood pressure will decrease after surgery, but if carotid sinus response occurs, high HDL (≧1.0mmol/L) may be more likely to require vasopressor therapy while low HDL (<1.0mmol/L) can be treated with fluid rehydration.

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Section: Discussionmentioning

confidence: 99%

HDL can predict the treatment of hypotension after CAS surgery for initial internal carotid artery stenosis

Ma,

Yang,

et al. 2024

Preprint

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“… 15 In a study conducted in Korea, fewer ischemic strokes were observed in patients with dyslipidemia. 16 Regarding the cholesterol profile, LDL-C levels are related to new diffusion-weighted image lesions observed in the acute phase immediately after CAS. 17 However, a long-term follow-up study demonstrated that low HDL-C level was an independent predictor of stroke, MI, and all-cause mortality after CAS, whereas LDL-C level was not.…”

Section: Discussionmentioning

confidence: 99%

Low-Density Lipoprotein Cholesterol Levels Are Associated With Subsequent Stented-Territory Ischemic Stroke After Carotid Artery Stenting: A Single Center Retrospective Study

Kim

Ryu

Koo

et al. 2023

J Lipid Atheroscler

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Objective The role of low-density lipoprotein cholesterol (LDL-C) after carotid artery stenting (CAS) is not well known with respect to stented-territory infarction (STI) and in-stent restenosis (ISR). We hypothesized that LDL-C levels after CAS might be independently associated with STI and ISR. Methods We conducted a retrospective study for patients with significant extracranial carotid stenosis who were subjected to CAS between September 2013 and May 2021. LDL-C levels were measured after 6 and 12 months following CAS. The association between STI and ISR, and LDL-C was explored using Cox proportional-hazard model. Results Of 244 patients enrolled, STI and ISR were observed in 11 (4.5%) and 10 (4.1%) patients, respectively. In multivariable analysis, higher white blood cell count (hazard ratio [HR], 1.408 per 10 3 /mm 3 ; 95% confidence interval [CI], 1.085–1.828; p =0.010), higher LDL-C levels after 12 months (HR, 1.037 per 1 mg/dL; 95% CI, 1.011–1.063; p =0.005), and ISR (HR, 13.526; 95% CI, 3.405–53.725; p <0.001) were independent predictors of STI. Diabetes (HR, 4.746; 95% CI, 1.026–21.948; p =0.046), smaller stent diameter (HR, 0.725 per 1 mm; 95% CI, 0.537–0.980; p =0.036), and higher LDL-C levels after 12 months (HR, 1.031 per 1 mg/dL; 95% CI, 1.007–1.055; p =0.011) were independent predictors of ISR. Conclusion We showed that LDL-C levels after 12 months independently predict STI and ISR after CAS. It is necessary to investigate the optimal target LDL-C level for STI prevention through well designed research in the future.

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“…3,6,7 Third, although CEA was principally recommended for revascularization of asymptomatic carotid stenosis, CAS has now been performed more frequently than CEA in some countries. 8 At this point, understanding the available evidence on revascularization treatment, especially focusing on CAS, can be helpful in setting up an optimal treatment strategy for asymptomatic carotid stenosis. Thus, this review aimed to pragmatically organize the information that is necessary for a clinical decision on CAS in asymptomatic carotid stenosis.…”

Section: Introductionmentioning

confidence: 99%

“…Such an improvement might result in attenuating the relative efficacy of revascularization treatment in asymptomatic carotid stenosis [ 3 , 6 , 7 ]. Third, although CEA was principally recommended for revascularization of asymptomatic carotid stenosis, CAS has now been performed more frequently than CEA in some countries [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Carotid Artery Stenting for Asymptomatic Carotid Stenosis: What We Need to Know for Treatment Decision

Baek

2023

Neurointervention

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A clinical decision on the treatment of asymptomatic carotid stenosis is challenging, unlike symptomatic carotid stenosis. Carotid artery stenting (CAS) has been recommended as an alternative to carotid endarterectomy (CEA) based on the finding that the efficacy and safety of CAS were comparable to CEA in randomized trials. However, in some countries, CAS is often performed more frequently than CEA for asymptomatic carotid stenosis. Moreover, it has been recently reported that CAS is not superior to the best medical treatment in asymptomatic carotid stenosis. Due to these recent changes, the role of CAS in asymptomatic carotid stenosis should be revisited. When determining the treatment for asymptomatic carotid stenosis, one should consider several clinical factors including stenosis degree, patient life expectancy, stroke risk by medical treatment, availability of a vascular surgeon, high risk for CEA or CAS, and insurance coverage. This review aimed to present and pragmatically organize the information that is necessary for a clinical decision on CAS in asymptomatic carotid stenosis. In conclusion, although the traditional benefit of CAS is being revisited recently, it seems too early to conclude that CAS is no longer beneficial under intense and systemic medical treatment. Instead, a treatment strategy with CAS should evolve to select eligible or medically high-risk patients more precisely.

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Comparison of Long Term Prognosis between Carotid Endarterectomy versus Stenting; A Korean Population-Based Study Using National Insurance Data

Cited by 7 publications

References 22 publications

HDL can predict the treatment of hypotension after CAS surgery for initial internal carotid artery stenosis

HDL can predict the treatment of hypotension after CAS surgery for initial internal carotid artery stenosis

Low-Density Lipoprotein Cholesterol Levels Are Associated With Subsequent Stented-Territory Ischemic Stroke After Carotid Artery Stenting: A Single Center Retrospective Study

Carotid Artery Stenting for Asymptomatic Carotid Stenosis: What We Need to Know for Treatment Decision

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