Early Outcomes After Carotid Endarterectomy and Carotid Artery Stenting for Carotid Stenosis in the ACS-NSQIP Database

Alhaidar, Mohammed K; AlGaeed, Mohanad; Amdur, Richard; Algahtani, Rami; Majidi, Shahram; Sigounas, Dimitri

doi:10.1016/j.jvs.2018.09.015

Cited by 7 publications

(5 citation statements)

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“…Postoperative stroke, MI, and mortality rates identified in this review are consistent with the national standard for both the SAPT and DAPT groups, and no difference was identified between study groups in this review. 28 DAPT has previously been associated with increased bleeding events perioperatively; however this finding has not been widely reproduced in the literature, and was not present in this study population. [29][30][31] There are several limitations to this study.…”

Section: Discussioncontrasting

confidence: 56%

Carotid Restenosis Following Endarterectomy in Patients Managed With Single Antiplatelet Therapy Versus Dual Antiplatelet Therapy

Glotzer

Rojas

Bouchard

et al. 2020

Vasc Endovascular Surg

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Background: Antiplatelet therapy is a cornerstone in the management of carotid artery disease following carotid endarterectomy (CEA). There is a paucity of data regarding the effect of dual antiplatelet therapy (DAPT) on restenosis rates. Methods: A retrospective review of patients who underwent CEA from January 1, 2007 to December 31, 2013 was performed at a single center. Study groups consisted of subjects who received DAPT and those who received single antiplatelet therapy (SAPT) following CEA. Restenosis was evaluated by carotid duplex. Severity and timing of restenosis, postoperative complications, and reinterventions were compared between study groups. Results: Between January 1, 2007 and December 31, 2013, 1453 patients underwent CEA. The SAPT group consisted of 245 patients and the DAPT group consisted of 1208 patients. No difference in restenosis was identified between groups at less than 6 weeks (6.5% vs. 11.7% 50-79% stenosis, 0% vs. 2.2% 80-99% stenosis, 2.2% vs. 0.6% occlusion, p = 0.368), and 6 weeks to 2 years (20.6% vs. 17.9% 50-79% stenosis, 1.1% vs. 1.0% 80-99% stenosis, 1.6% vs. 0.4% occlusion, p = 0.242). A higher rate of restenosis in SAPT was found greater than 2 years from surgery (68.4% vs. 82.4% <50% stenosis, 29.9% vs. 16.1% 50-79% stenosis, 0% vs. 0.6% 80-99% stenosis, 1.7% vs. 0.9% occlusion p = 0.004). This finding persisted on multivariable analysis with 31.6% of the SAPT group showing >50% stenosis vs. 17.6% of the DAPT group (adjusted OR 0.48, 95% CI 0.30-0.76, p = 0.002). In a propensity matched-population, 32.7% of the SAPT group demonstrated restenosis vs. 13.7% of the DAPT group (adjusted OR 0.35, 95% CI 0.16-0.77, p = 0.009). There was no difference in the need for reintervention between study groups (DAPT 3.8% vs SAPT 3.3%, p = 0.684). Conclusion: Following CEA, patients on DAPT exhibited lower rates of late restenosis. Despite this finding, a clinical difference in reintervention was not found during this study period.

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Section: Discussioncontrasting

confidence: 56%

Carotid Restenosis Following Endarterectomy in Patients Managed With Single Antiplatelet Therapy Versus Dual Antiplatelet Therapy

Glotzer

Rojas

Bouchard

et al. 2020

Vasc Endovascular Surg

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“…The results of selected prospective and retrospective analyses of CEA and CAS are presented in Tables 4A and 4B. 2,[17][18][19][20][21][22][23][24][25][26][27][28][29] Accounting for variation in recruitment of patients for these studies, rates of stroke, MI, and death at 30 d were broadly similar in our patient cohort as compared to other retrospective analyses and generally lower than rates reported in randomized controlled trials. For patients undergoing CAS, the reported rate of stroke was significantly lower than those identified in other randomized controlled trials and some number of retrospective analyses, as well.…”

Section: Discussionsupporting

confidence: 55%

Early Outcomes After Carotid Endarterectomy and Carotid Artery Stenting: A Propensity-Matched Cohort Analysis

et al. 2021

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BACKGROUND Carotid endarterectomy (CEA) and carotid artery stenting (CAS) represent options to treat many patients with carotid stenosis. Although randomized trial data are plentiful, estimated rates of morbidity and mortality for both CEA and CAS have varied substantially. OBJECTIVE To evaluate rates of adverse outcomes after CAS and CEA in a large national database. METHODS We analyzed 84 191 adult patients undergoing elective, nonemergent CAS (n = 81 361) or CEA (n = 2830), from 2011 to 2018, in the American College of Surgeons’ National Surgical Quality Improvement Program database. Odds of adverse outcomes (30-d rates of stroke, myocardial infarction (MI), cardiac arrest, prolonged length of stay (LOS), readmission, reoperation, and mortality) were evaluated in propensity-matched (n = 2821) cohorts through logistic regression. RESULTS In the propensity-matched cohorts, CAS had increased odds of periprocedural stroke (odds ratio [OR] 1.97, 95% CI 1.32-2.95) and decreased odds of cardiac arrest (OR 0.33, 95% CI 0.13-0.84) and 30-d reoperation (OR 0.59, 95% CI 0.44-0.80) compared to CEA. Relative odds of MI, prolonged LOS, discharge to destination other than home, 30-d readmission, or 30-d mortality were statistically similar. In the unmatched patient population, rates of adverse outcomes with CEA were constant over time; however, for CAS, rates of stroke increased over time. In both the matched and unmatched patient cohorts, patients 70 yr and older had lower rates of post-procedural stroke with CEA, but not with CAS, compared to younger patients. CONCLUSION In a propensity-matched analysis of a large, prospectively collected, national, surgical database, CAS was associated with increased odds of periprocedural stroke, which increased over time. Rates of MI and death were not significantly different between the 2 procedures.

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“…Carotid endarterectomy (CEA) is a surgical treatment option to prevent ischemic cerebrovascular accidents (1). CEA has proven to be a successful treatment strategy, but remains a surgical procedure with the risk for adverse post-operative outcomes such as postprocedural disabling stroke, myocardial infarction and mortality (2). Advanced age, female gender and comorbidities in CEA patients are proved to be associated with such unfavorable outcomes (1,3,4).…”

Section: Introductionmentioning

confidence: 99%

Role of pre-operative frailty status in relation to outcome after carotid endarterectomy: a systematic review

Benjamens¹,

Bokkers²,

Zeebregts³

et al. 2021

Ann Transl Med

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Carotid endarterectomy (CEA) is a surgical treatment option to prevent ischemic cerebrovascular accidents. Patients that present with pre-operative frailty might have an elevated risk for unfavorable outcomes after the CEA. A systematic search, using Medline, Embase, Web of Science and Cochrane Database, was performed for relevant literature on frailty in patients undergoing CEA. The study protocol was registered with PROSPERO (CRD42020190345). Eight articles were included. The pooled prevalence for pre-operative frailty was 23.9% (95% CI: 12.98-34.82). A difference in the incidence of complications between frail and non-frail patients (6.4% vs. 5.2%, respectively) and a difference in hospital length of stay [2 (IQR: 2-3) days vs. 1 (IQR: 1-2) day, respectively] were described. The 30-day mortality after CEA was 0.6% for non-frail patients, 2.6% for frail patients, and 4.9% for very frail patients (P<0.001). For 3-year mortality, a >1.5-fold increased risk was found for frail patients (OR 1.7, 95% CI: 1.4-2.0) and a >2.5-fold increased risk for very frail patients (OR 2.6, 95% CI: 2.2-3.1). In conclusion, this review shows the impact of frailty on outcome after CEA. Pre-operative frailty assessment with a validated, multi-domain tool should be implemented in the clinical setting as it will provide information on post-operative surgical outcomes and mortality risk but also frailty trajectory and cognitive decline.

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Early Outcomes After Carotid Endarterectomy and Carotid Artery Stenting for Carotid Stenosis in the ACS-NSQIP Database

Cited by 7 publications

References 0 publications

Carotid Restenosis Following Endarterectomy in Patients Managed With Single Antiplatelet Therapy Versus Dual Antiplatelet Therapy

Carotid Restenosis Following Endarterectomy in Patients Managed With Single Antiplatelet Therapy Versus Dual Antiplatelet Therapy

Early Outcomes After Carotid Endarterectomy and Carotid Artery Stenting: A Propensity-Matched Cohort Analysis

Role of pre-operative frailty status in relation to outcome after carotid endarterectomy: a systematic review

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