Early Outcomes of Carotid Revascularization in Retrospective Case Series

Nana, Petroula; Kouvelos, George; Brotis, Alexandros; Σπανός, Κωνσταντίνος; Dardiotis, Efthimios; Matsagkas, Miltiadis; Giannoukas, Athanasios D.

doi:10.3390/jcm10050935

Cited by 3 publications

(3 citation statements)

References 36 publications

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“…In the present study, the incidence of composite complications (death, stroke, or MI) during the first 30 days after the CAS was 2.6%. This rate was 4.4% (symptomatic and asymptomatic), 9.6% (symptomatic), 7.7% (symptomatic), 5.1% (symptomatic and asymptomatic), 8.5% (symptomatic, at 120 days), and 4.23% (symptomatic and asymptomatic) in CAS arm of SAPPHIRE, 23 EVA‐3S, 24 SPACE, 25 CREST, 26 ICSS 12 trials, and a metanalysis of 15 retrospective case series, 27 respectively. The 30‐day complication rates in the current study were lower than observed in previous studies but comparable to more recent studies 28,29 .…”

Section: Discussionmentioning

confidence: 95%

“…(symptomatic, at 120 days), and 4.23% (symptomatic and asymptomatic) in CAS arm of SAPPHIRE, 23 EVA-3S, 24 SPACE, 25 CREST, 26 ICSS 12 trials, and a metanalysis of 15 retrospective case series, 27 respectively. The 30-day complication rates in the current study were lower than observed in previous studies but comparable to more recent studies.…”

Section: Discussionmentioning

confidence: 99%

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Early and mid‐term outcomes of carotid angioplasty and stent placement in 579 patients

Borhani‐Haghighi

Hooshmandi

Zahediasl

et al. 2022

Journal of Neuroimaging

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Background and Purpose Carotid angioplasty and stenting (CAS) could be considered for preventing stroke in patients with carotid artery stenosis. This study aimed to determine the incidence and the risk factors of the early and mid‐term complications associated with CAS. Methods This is a retrospective cohort study conducted at Shiraz University of Medical Sciences from March 2011 to March 2019. Patients at high risk and standard risk for carotid endarterectomy were included. The primary composite outcome was defined as stroke, myocardial infarction (MI), and death in the first 30 days after CAS. All‐cause mortality, vascular mortality, and stroke were investigated during mid‐term follow‐up. Results A total of 579 patients (618 CAS) were recruited (mean age: 71.52 years). Overall, 394 (68.40%), 211 (36.63%), 179 (31.07%), and 96 (16.72%) patients had hypertension, dyslipidemia, diabetes mellitus, or were cigarette smokers, respectively. Primary composite outcomes were observed in 2.59% of patients (1.55% stroke, 0.69% MI, and 1.72% death). Atrial fibrillation was a predictor of primary composite outcome in multivariate logistic regression (p = .048). The presence of total occlusion in the contralateral carotid artery was significantly associated with the risk of stroke in univariate logistic regression (p = .041). The patients were followed for a period ranging from 1 to 83 months. The overall survival rate for all‐cause mortality was 93.48% at 1 year, 77.24% at 5 years, and 52.92% at 8 years. All‐cause mortality was significantly higher among patients with symptomatic carotid stenosis (p = .014). Conclusion CAS provides acceptable short‐term and mid‐term outcomes in a unique population of high‐ and standard‐surgical‐risk, symptomatic and asymptomatic, octogenarian, and nonoctogenarian patients.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Early and mid‐term outcomes of carotid angioplasty and stent placement in 579 patients

Borhani‐Haghighi

Hooshmandi

Zahediasl

et al. 2022

Journal of Neuroimaging

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“…Furthermore, in asymptomatic low-risk surgical patients with severe carotid stenosis, comparison of stroke, death, and myocardial infarction rates within 30 days, at 1and 5-years following CAS with emboli protection device or CEA revealed nonsignificant differences (11). A recent meta-analysis of real-world practices of both CAS and SEA concluded non-significant differences of the 30-day neurologic events (CEA: 2.1% and CAS: 2.6%) (12).…”

Section: Discussionmentioning

confidence: 98%

Which is worthy to be adopted, carotid endarterectomy or carotid stenting for treatment of symptomatic carotid artery stenosis?

et al. 2022

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Background: Carotid endarterectomy (CEA) has shown a valuable role in preventing stroke in symptomatic patients. However, it is limited by the presence of high-risk medical conditions. Alternatively, carotid artery stenting (CAS) has evolved as a less invasive therapeutic method.Objective: This study aimed to compare between outcomes of artery stenting and carotid endarterectomy in asymptomatic carotid artery stenosis patients.Methods: This retrospective cohort included 37 adult patients with symptomatic carotid artery stenosis. Patients were scheduled for either CAS (N=20) or CEA (N=17). The records were reviewed, and the patients' demographics, comorbidities, and clinical data were recorded. Carotid artery assessment via carotid duplex ultrasonography was also recorded. The primary endpoint of the study was the incidence of myocardial infarction or stroke within 30-days, and the incidence of death, stroke, or myocardial infarction at 1-year. The secondary endpoints included cranial nerve injury, restenosis, vessel maturation, intracranial haemorrhage, and any complications at the surgical site within one month after the procedures.Results: Within 30 days of the procedures, the incidence of stroke or transient ischemic attack was 20.0% in the CAS group compared with 17.6% in the CEA group with no significant difference (p>0.999). Myocardial infarction did not ensue in either group. No patients in the CAS group developed cranial nerve injury compared to two patients (11.8%) in the CEA group, with no significant difference (p=0.204). The occurrence of local hematoma was lower in the CAS group (5.0%) than in the CEA group (29.4%), but it did not reach a significant level (p=0.075). A 1-year follow-up, equal death, and stroke rates in the CAS and CEA groups were 10.0% versus 11.8% (p>0.999).Conclusions: Data from our present study indicate comparable death, stroke, or myocardial infarction rates within one month and at 1-year follow-up among patients who underwent CAS or CEA. Furthermore, there were no significant differences between CEA and CAS procedures regarding incidence rates of cranial nerve injury, local neck hematoma, or restenosis within one month of the procedures.

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Carotid Artery Stenting in Patients with Symptomatic and Asymptomatic Stenosis: In-Hospital Clinical Outcomes at a Single Neurovascular Center

Hajiyev

Hellstern

Cimpoca

et al. 2022

JCM

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Background: Carotid artery stenting (CAS) is a minimally invasive and proven percutaneous procedure that is widely used to treat patients with symptomatic and asymptomatic carotid artery stenosis. The purpose of this study was to characterize the in-hospital outcomes of symptomatic and asymptomatic patients undergoing CAS at a single neurovascular center. Methods: The study was conducted as a retrospective analysis of 1158 patients (asymptomatic, n = 636; symptomatic, n = 522; male, n = 816; median age, 71 years; NASCET method, 70–99% stenosis, n = 830) who underwent CAS between May 2009 and December 2020. In-hospital neurological outcomes, adverse reactions to iodinated contrast media, acute myocardial infarction, intraprocedural complications, and access-site issues were evaluated. The primary endpoints were disabling stroke (including disabling cerebral hyperperfusion syndrome [CHS]) and all in-hospital deaths. Results: A carotid stent could not be deployed in one patient due to calcified plaques (technical failure rate of 0.09%). Four patients (0.3%) experienced in-hospital, stroke-associated death, while five patients (0.4%) died from non-stroke-related causes. All stroke-associated deaths occurred in the symptomatic group and were due to CHS. The disabling stroke rate was 0.9% overall (n = 10; 0.5% versus 1.3% in asymptomatic versus symptomatic patients, respectively). Nineteen patients (1.6%) reached the in-hospital primary endpoint. More patients in the symptomatic group achieved this endpoint than in the asymptomatic group (2.5% versus 0.9%, respectively; p = 0.060). Conclusions: An evaluation was conducted on the in-hospital outcomes of 1158 patients at a single center who underwent CAS and was performed by trained physicians who were supervised by a senior neurovascular interventionist with over 20 years of experience, confirming the excellent safety profile of this procedure with a low rate of complications.

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Early Outcomes of Carotid Revascularization in Retrospective Case Series

Cited by 3 publications

References 36 publications

Early and mid‐term outcomes of carotid angioplasty and stent placement in 579 patients

Early and mid‐term outcomes of carotid angioplasty and stent placement in 579 patients

Which is worthy to be adopted, carotid endarterectomy or carotid stenting for treatment of symptomatic carotid artery stenosis?

Carotid Artery Stenting in Patients with Symptomatic and Asymptomatic Stenosis: In-Hospital Clinical Outcomes at a Single Neurovascular Center

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