Impact of chronic kidney disease in patients undergoing percutaneous or surgical carotid artery revascularization: Insights of the healthcare cost and utilization Project's National Inpatient Sample

Lima, Fabio V.; Yen, Tzyy Yun M.; Butler, Javed; Yang, Jie; Xu, Jianjin; Gruberg, Luis

doi:10.1016/j.carrev.2016.08.014

Cited by 8 publications

(7 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…151 On the other hand, a recent study on the impact of CKD in patients undergoing surgical carotid artery revascularization reported substantial differences in the procedures used for revascularization (carotid artery stenting/carotid artery endarterectomy) as a function of other disorders such as diabetes mellitus, hypertension, hyperlipidemia, and coronary artery disease. 152 This study also showed that among CKD cohorts, in-hospital major adverse cardiovascular and cerebrovascular events were higher for patients who underwent carotid artery stenting. Since the recombinant tPA-induced thrombolysis is the best available option currently, an understanding of the bleeding complications and hemorrhagic transformation due to endogenous as well as exogenous tPA is necessary.…”

Section: Thrombolysis After Acute Ischemic Stroke In Ckdmentioning

confidence: 58%

Chronic kidney disease in the pathogenesis of acute ischemic stroke

Chelluboina

Vemuganti

2019

J Cereb Blood Flow Metab

View full text Add to dashboard Cite

Chronic kidney disease has a graded and independent inverse impact on cerebrovascular health. Both thrombotic and hemorrhagic complications are highly prevalent in chronic kidney disease patients. Growing evidence suggests that in chronic kidney disease patients, ischemic strokes are more common than hemorrhagic strokes. Chronic kidney disease is asymptomatic until an advanced stage, but mild to moderate chronic kidney disease incites various pathogenic mechanisms such as inflammation, oxidative stress, neurohormonal imbalance, formation of uremic toxins and vascular calcification which damage the endothelium and blood vessels. Cognitive dysfunction, dementia, transient infarcts, and white matter lesions are widespread in mild to moderate chronic kidney disease patients. Uremic toxins produced after chronic kidney disease can pass through the blood–brain barrier and mediate cognitive dysfunction and neurodegeneration. Furthermore, chronic kidney disease precipitates vascular risk factors that can lead to atherosclerosis, hypertension, atrial fibrillation, and diabetes. Chronic kidney disease also exacerbates stroke pathogenesis, worsens recovery outcomes, and limits the eligibility of stroke patients to receive available stroke therapeutics. This review highlights the mechanisms involved in the advancement of chronic kidney disease and its possible association with stroke.

show abstract

Section: Thrombolysis After Acute Ischemic Stroke In Ckdmentioning

confidence: 58%

Chronic kidney disease in the pathogenesis of acute ischemic stroke

Chelluboina

Vemuganti

2019

J Cereb Blood Flow Metab

View full text Add to dashboard Cite

show abstract

“…These comparisons have rarely been made in previous studies, including the CREST clinical trial [46,35]. Previous studies that have analyzed the influence of individual coexisting diseases on the effectiveness of CEA compared with CAS as assessed by the SF-36 QoL index did not assess several important comorbidities [78], which were identified as relevant in the present study. In the CREST cohort study, which included about 50% of patients with asymptomatic carotid artery stenosis, the role of symptomatic status on QoL was not investigated [35,61].…”

Section: Discussionmentioning

confidence: 93%

“…This study was cross-sectional and non-randomized and was a small study conducted in a single center. Although the study controlled several major variables (Table 1), not all HR-QoL determinants were controlled for, other than ischemic stroke, MI, and mortality, and it is possible that conditions such as atrial fibrillation (AF) [77], arthritis [36,81], lung disease other than COPD [82], and chronic kidney disease [78,79] may have affected the results regarding the impact of CEA compared with CAS on HR-QoL as reported by the patients (Table 2). We were not able to assess the impact of exercise [83,84], lifestyle [38], social support [85], or living in rural areas compared with urban areas [86].…”

Section: Discussionmentioning

confidence: 99%

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

Pąchalska

2019

Med Sci Monit

View full text Add to dashboard Cite

Background This study aimed to evaluate the relationship between existing comorbidities and the effectiveness of revascularization of asymptomatic critical internal carotid artery (ICA) stenosis treated with carotid endarterectomy (CEA) or carotid artery stenting (CAS) and short-term and long-term outcome in terms of health-related quality of life (HRQoL). Material/Methods Patients with asymptomatic critical ICA stenosis (n=62) included a group treated with CEA (n=31) and a group treated with CAS (n=31). A Health Assessment Questionnaire designed for this study was used to assess ten comorbidities, and the Short Form 36 Health Survey Questionnaire (SF-36) was used to evaluate HRQoL following CEA and CAS. Results Three comorbidities significantly influenced the effectiveness of revascularization in all patients studied who underwent CEA and CAS, which included symptomatic atherosclerosis in other vascular areas (p=0.048), coronary artery disease (CAD) (p=0.004), and previous myocardial infarction (MI) (p=0.004). In the CEA group, CAD and previous MI were significant comorbidities (p=0.002), when compared with the CAS group (p=0.635). In the CAS group, chronic obstructive pulmonary disease (COPD) was a significant comorbidity in terms of outcome (p=0.025). Conclusions The comorbidities of atherosclerotic vascular disease, CAD, and previous MI had a significant influence of the effectiveness of the revascularization and postoperative HRQoL in all patients studied with asymptomatic critical ICA stenosis who were treated with CEA and CAS. When the two groups were compared, CAD and previous MI were significant comorbidities in the CEA group, and COPD was a significant comorbidity in the CAS group.

show abstract

“…Moreover, CEA has shown promising results for stroke risk reduction in CKD patients with high-grade symptomatic carotid stenosis (124). In a National Inpatient Sample surveyed for CAS and CEA among CKD stage 3-5 and ESKD patients, although CAS was independently associated with in-hospital major adverse CV and cerebrovascular events (MACCE), propensity score matching showed no risk difference in MACCE between CAS and CEA (125). After intervention for carotid artery stenosis, stroke rate is low in patients with moderate-severe CKD whereas mortality increases with worsening renal function at 30-day (126); severe CKD is associated with cerebrovascular events or death at 1 and 5 years of follow-up (126,127).…”

Section: Treatment Optionsmentioning

confidence: 99%

Narrative Review of Carotid disease and the kidney

Zanoli

Mikhailidis

2021

Ann Transl Med

View full text Add to dashboard Cite

Patients with chronic kidney disease (CKD) have an increased cardiovascular (CV) risk that is only in part explained by established risk factors. Carotid arteriosclerosis and atherosclerosis are increased in CKD, play a role in the causation of CV disease in these patients and can affect the progression of renal disease. The arterial stiffening process is evident even in CKD patients with a very mild reduction of glomerular filtration rate (GFR) whereas arterial thickening is evident in more advanced stages. Possible mechanisms include functional and structural alterations of the arterial wall. Arterial stiffness can mediate the effect of CKD on target organs (i.e., brain, kidney and heart). In this review we discuss the arterial phenotype of patients with CKD. This is characterized by increased common carotid artery stiffness and outward remodeling (enlargement and thickening of the arterial wall) and a normal/reduced stiffness paired with an inward remodeling (narrowing of the arterial wall) of muscular arteries. We also discuss the consequences of carotid dysfunction, including the involvement of large elastic arteries stiffness on ventricular-vascular coupling, the mechanisms linking carotid stiffening and increased cardio-and cerebrovascular risk in CKD patients, and the therapeutic options to improve carotid function.

show abstract

Impact of chronic kidney disease in patients undergoing percutaneous or surgical carotid artery revascularization: Insights of the healthcare cost and utilization Project's National Inpatient Sample

Cited by 8 publications

References 33 publications

Chronic kidney disease in the pathogenesis of acute ischemic stroke

Chronic kidney disease in the pathogenesis of acute ischemic stroke

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

Narrative Review of Carotid disease and the kidney

Contact Info

Product

Resources

About