Impact of postoperative transient ischemic attack on survival after carotid revascularization

Pini, Rodolfo; Faggioli, Gianluca; Longhi, Matteo; Mauro, Raffaella; Freyrie, Antonio; Gargiulo, Mauro; Stella, Andréa

doi:10.1016/j.jvs.2013.12.048

Cited by 18 publications

(13 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the analysis of risk factors for CEA, the presence of SCI is rarely considered; we can only analyze other risk factors that can be indirectly associated with the presence of SCI such as previous cerebral symptoms and atrial fibrillation. 24,[34][35][36] Atrial fibrillation was more frequent in patients with SCI in our study. These patients may have an adjunctive risk, 24 either for the higher cardioembolic potential or for the risk of the anticoagulant therapy.…”

Section: Discussionsupporting

confidence: 50%

The detrimental impact of silent cerebral infarcts on asymptomatic carotid endarterectomy outcome

Pini

Faggioli

Longhi

et al. 2016

Journal of Vascular Surgery

Self Cite

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 50%

The detrimental impact of silent cerebral infarcts on asymptomatic carotid endarterectomy outcome

Pini

Faggioli

Longhi

et al. 2016

Journal of Vascular Surgery

Self Cite

View full text Add to dashboard Cite

show abstract

“…The incidence rate of TIA is in accordance with the stroke/death rate within 30 d. Recent studies have demonstrated that overall survival is significantly lower in patients with postoperative TIA, which is an independent predictor of decreased survival at the 5-year follow-up. 66 …”

Section: Discussionmentioning

confidence: 99%

Systematic Review and Meta-Analysis of Carotid Artery Stenting Versus Endarterectomy for Carotid Stenosis

et al. 2015

View full text Add to dashboard Cite

There are disparities among the results of meta-analyses under different circumstances of carotid artery stenting (CAS) versus endarterectomy (CEA) for carotid stenosis. This study aimed to assess the efficacies of CAS and CEA for carotid stenosis at 5-year intervals and worldwide.Comparative studies simultaneously reporting CAS and CEA for carotid stenosis with at least 10 patients in each group were identified by searching PubMed and Embase in accordance with preferred reporting items for systematic reviews and meta-analyses guidelines, and by reviewing the reference lists of retrieved articles.The studies were stratified into different subgroups according to the publication year, location in which the study was mainly performed, and randomized and nonrandomized study designs.Thirty-five comparative studies encompassing 27,525 patients were identified. The risk ratios (RRs) of stroke/death when CAS was compared with CEA within 30 d of treatment were 1.51 (95% CI 1.32–1.74, P < 0.001) for overall, 1.50 (95% CI 1.14–1.98, P = 0.004) from 2011 to 2015, 1.61 (95% CI 1.35–1.91, P < 0.001) from 2006 to 2010, 1.59 (95% CI 1.27–1.99, P < 0.001) in North America, 1.50 (95% CI 1.24–1.81, P < 0.001) in Europe, 1.63 (95% CI 1.31–2.02, P < 0.001) for randomized, and 1.44 (95% CI 1.20–1.73, P < 0.001) for nonrandomized comparative studies. CEA decreased the risks of transient ischemic attack at 30 d (RR: 2.07, 95% CI 1.50–2.85, P < 0.001) and restenosis at 1-year (RR: 1.97, 95% CI 1.28–3.05, P = 0.002). Data from follow-up showed that the RRs of stroke/death were 0.74 (95% CI 0.55–0.99, P = 0.04) at 1 year, 1.24 (95% CI 1.04–1.46, P = 0.01) at 4 year, and 2.27 (95% CI 1.39–3.71, P = 0.001) at 10 year. This systematic review, compared with those of other meta-analyses, included all available comparative studies and analyzed them at 5-year intervals, in different continents, and under different study designs. Current evidence suggests that the efficacy of CEA is superior to CAS for freedom from stroke/death within 30 d, especially from 2006 to 2015, in North America and Europe. Meanwhile, the superiority was also observed for restenosis at 1-year, transient ischemic attack within 30 d, and stroke/death at 4- and 10-year follow-ups.

show abstract

“…1 Clinical characteristics, technical aspects and perioperative (30-day) outcome were prospectively entered into a dedicated database in each of the two tertiary hospitals. As previously presorted, 13,14 the clinical characteristics included the following: age; sex; hypertension (presence of systolic blood pressure >140 or/and diastolic >90 mmHg, or specific therapy); dyslipidemia (total cholesterol >200 mg/dl or low density lipoprotein >120 mg/dl or specific therapy); diabetes mellitus (pre-diagnosed in therapy with oral hypoglycemic drugs or with insulin); current smoking; coronary artery disease (defined as a history of angina pectoris, myocardial infarction or coronary revascularization); chronic obstructive pulmonary disease (defined as chronic bronchitis or emphysema); chronic renal failure (glomerular filtration rate <60 ml/min); contralateral carotid occlusion and atrial fibrillation (paroxysmal or permanent). Perioperative medical therapy was also considered: specifically, single or double antiplatelet therapy, statins and oral anticoagulant therapy.…”

Section: Patient Selectionmentioning

confidence: 66%

The different scenarios of urgent carotid revascularization for crescendo and single transient ischemic attack

et al. 2018

Self Cite

View full text Add to dashboard Cite

Objective Carotid stenosis with crescendo-transient-ischemic-attack (cTIA) requires a prompt intervention to reduce the stroke risk. Few data are reported in literature about cTIA suggesting a different perioperative risk compared with patients with single TIA (sTIA). This study aimed to compare the outcome of carotid endarterectomy (CEA) in patients with TIA (single/crescendo) and evaluate the outcome risk-factors. Methods Data from two tertiary hospitals for vascular treatment were analyzed from 2007 to 2016. All patients with TIA subjected to CEA were considered, comparing the 30-day postoperative stroke and stroke/death in patients with cTIA and sTIA, particularly in the urgent (≤48 h) setting. Results On a total of 3866 CEA, 888 (23%) were performed in symptomatic patients and 515 for TIA: 365 (71%) patients with sTIA and 150 (29%) with cTIA. When compared with sTIA, cTIA patients were younger and less frequently affected by coronary disease, dyslipidemia, and chronic pulmonary disease; however, contralateral carotid occlusion was more common (20% vs. 10%, P = .004; 56% vs. 46, P = .03; 16% vs. 7%, P = .01; >80 years 26% vs. 16%, P = .01 and 2% vs. 10%, P = .001; respectively). Postoperative stroke and stroke/death were significantly higher in cTIA compared with sTIA (5.3% vs. 1.6%, P = .02 and 6.0% vs. 2.2%, P = .03; respectively). Urgent CEA was performed in 58% ( n: 87) cTIA and in 11% ( n: 56) sTIA( P<.01). The urgent setting did not influence the stroke and stroke/death rate of CEA for sTIA (3.6% vs. 1.3%, P = .21 and 3.6% vs. 1.9%, P = .44, respectively), but was associated with lower rate of events in cTIA (1.1%vs. 11.1%, P = .01 and 2.3% vs. 11.1%, P = .03, respectively). This beneficial effect in patients with cTIA treated within 48-h was confirmed also by multivariate analysis (OR: 0.09, 95% CI: 0.76-0.01, P=.02). Conclusions cTIA subjected to CEA have a higher stroke and stroke/death risk compared with patients with sTIA. The urgent setting seems to reduce the stroke/death rate cTIA; for sTIA with a stable neurological condition, the timing of CEA did not influence the outcome.

show abstract

Impact of postoperative transient ischemic attack on survival after carotid revascularization

Cited by 18 publications

References 29 publications

The detrimental impact of silent cerebral infarcts on asymptomatic carotid endarterectomy outcome

The detrimental impact of silent cerebral infarcts on asymptomatic carotid endarterectomy outcome

Systematic Review and Meta-Analysis of Carotid Artery Stenting Versus Endarterectomy for Carotid Stenosis

The different scenarios of urgent carotid revascularization for crescendo and single transient ischemic attack

Contact Info

Product

Resources

About