Late Outcomes After Carotid Artery Stenting Versus Carotid Endarterectomy

Bangalore, Sripal; Bhatt, Deepak L.; Röther, Joachim; Alberts, Mark J.; Thornton, Julie; Wolski, Kathy; Goto, Shinya; Hirsch, Alan T.; Smith, Sidney C.; Aichner, F.; Topakian, Raffi; Cannon, Christopher P.; Steg, Philippe Gabriel

doi:10.1161/circulationaha.109.933341

Cited by 27 publications

(7 citation statements)

References 37 publications

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“…Because early screening for GDM is risk-based, we utilized inverse probability of treatment weighting to account for the baseline imbalances in maternal characteristics between women diagnosed with GDM before and after 24 weeks. This strategy has been successfully employed in other disciplines such as the cardiovascular literature 36 to address some of the baseline imbalances that occur in observational studies. However, one limitation to inverse probability of treatment weighting is that is cannot account for unmeasured confounding, and although we were able to account for a broad number of clinical and demographic variables it is possible that there are metabolic factors that we were unable to account for in women diagnosed with GDM before 24 weeks.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy outcomes in women with an early diagnosis of gestational diabetes mellitus

Feghali

Abebe

Comer

et al. 2018

Diabetes Research and Clinical Practice

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Section: Discussionmentioning

confidence: 99%

Pregnancy outcomes in women with an early diagnosis of gestational diabetes mellitus

Feghali

Abebe

Comer

et al. 2018

Diabetes Research and Clinical Practice

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“…Therapeutic measures for ischemic stroke include medical treatment, interventional therapy, ischemic preconditioning, and surgical strategy 11,12 . As an important treatment for symptomatic severe stenosis of ICA 13–15 , the benefit of CEA has been limited by the perioperative complications. Temporary cerebral hypoperfusion and potential ischemic injury during cross-clamping may occur in some patients, especially in those without well-developed collateral circulation.…”

Section: Discussionmentioning

confidence: 99%

The Efficacy of Near-Infrared Spectroscopy Monitoring in Carotid Endarterectomy: A Prospective, Single-Center, Observational Study

Wang

et al. 2018

Cell Transplant

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There has been no gold standard for intraoperative monitoring in carotid endarterectomy (CEA) till now. The purpose of the current study was to investigate the value of near-infrared spectroscopy (NIRS) monitoring in CEA and explore the thresholds for intraoperative cerebral hypoperfusion. Eighty-four consecutive patients who underwent CEA surgery in Xuan Wu Hospital of Capital Medical University from August 2015 to June 2016 were enrolled in this study. All patients were intraoperatively monitored by transcranial Doppler ultrasonography (TCD) and NIRS. Regional oxygen saturation (rSO2) monitored by NIRS and blood flow velocity of the middle cerebral artery (V-MCA) monitored by TCD were continuously recorded. Correlation analysis was conducted for NIRS and TCD monitoring values. Intraoperative shunting was performed in five patients according to the TCD monitoring results and surgeon preference. During clamping of the carotid artery, the Pearson correlation index between rSO2 and V-MCA was 0.581 (P<0.001). A cut-off of 12.3% decrease of rSO2 was identified as the optimal threshold for intraoperative hypoperfusion indicated by TCD monitoring, when the sensitivity and specificity were 74.6% and 91.7%, respectively, with a 0.609 Kappa value. Physical examination immediately after operation showed no ischemic injury occurred, and no death and stroke occurred during the postoperative hospitalization. Our study demonstrated that NIRS could serve as a favorable monitoring tool during CEA. A 12.3% decrease of rSO2 could be adopted as a reliable threshold for intraoperative cerebral hypoperfusion.

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“…Despite the high flying goal, the author firmly believes that CAS should not only be superior to CEA in terms of overall mortality and morbidity, but also at least non-inferior in terms of long term follow up related to cerebrovascular disease (stroke, transient ischemic attacks, cerebral cognitive changes, and so on). For the time being, data may suggest slight superiority of CEA over CAS when only neurological outcome is examined [1-3]. In order to rectify this skewness, interventionalists should exert short term constraint in patient selection.…”

Section: It Is In the Interest Of Interventionalists To “Set The Bar mentioning

confidence: 99%

Carotid Artery Stenting 2013: Thumbs up

Wagdi

2013

Cardiol Res

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It has been customary for interventional cardiologists involved in carotid artery stenting, to underline non-inferiority of the percutaneous technique versus surgical carotid endarterectomy. To that end, all cause morbidity and mortality figures of both methods are compared. Surgery has, in most large randomized studies, had an edge over stenting in terms of cerebrovascular adverse events. This may have partly been due to occasional indiscriminate indication for stenting in lesions and/or vessels with unfavourable characteristics (severe target vessel tortuosity and calcification, Type III aortic arch, and so on). On one hand, the author pleads for improvement of the excellent results of endarterectomy, by subjecting all patients planned for surgery to a thorough preoperative cardiological work up, including generous invasive investigation, thus reducing the incidence of perioperative myocardial infarction, heart failure and cardiac death. On the other hand, we are convinced that the results of carotid stenting should then be compared to best practice surgery. The rate of neurological adverse event rate after carotid endarterectomy at our institution lies under 0.7% at 30 days postoperatively. Specifically, the goal should be that carotid stenting underbids surgical endarterectomy, also and mainly, in terms of cerebral and cerebrovascular adverse events. Cardiac morbidity and mortality as well as laryngeal nerve palsy should no more be the main arguments for the percutaneous approach. This should easily be possible if patient selection for carotid revascularisation would be approached according to morphological criteria, in analogy with the “Syntax”-score used to optimise revascularisation strategies in coronary artery disease.

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Late Outcomes After Carotid Artery Stenting Versus Carotid Endarterectomy

Cited by 27 publications

References 37 publications

Pregnancy outcomes in women with an early diagnosis of gestational diabetes mellitus

Pregnancy outcomes in women with an early diagnosis of gestational diabetes mellitus

The Efficacy of Near-Infrared Spectroscopy Monitoring in Carotid Endarterectomy: A Prospective, Single-Center, Observational Study

Carotid Artery Stenting 2013: Thumbs up

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