Prediction Models for Clinical Outcome After a Carotid Revascularization Procedure

Volkers, Eline J.; Algra, Ale; Kappelle, L. Jaap; Jansen, Olav; Howard, George; Hendrikse, Jeroen; Halliday, Alison; Gregson, John; Fraedrich, Gustav; Eckstein, Hans‐Henning; Calvet, D.; Brown, Martin M.; Becquemin, Jean‐Pierre; Ringleb, Peter; Mas, Jean‐Louis; Bonati, Leo H.; Brott, Thomas G.; Greving, Jacoba P.

doi:10.1161/strokeaha.117.020486

Cited by 16 publications

(19 citation statements)

References 23 publications

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“…This proves that the infection/sepsis rates found in our study were not in excess of those in the existing literature [29]. There are over 40 models for predicting short-and long-term outcomes after carotid revascularization [30]. However, the prediction models available have the following potential limitations.…”

Section: Discussionsupporting

confidence: 58%

“…There are over 40 models for predicting short- and long-term outcomes after carotid revascularization [ 30 ]. However, the prediction models available have the following potential limitations.…”

Section: Discussionmentioning

confidence: 99%

“…C -statistic (or area under the curve) is considered an important discriminating factor for the accuracy of a prediction model with scores of < 0.50, > 0.50–0.70, > 0.70–0.80, < 0.80–0.90, and > 0.90 representing no, poor, low, excellent, and outstanding discrimination, respectively [ 31 , 32 ]. Volkers et al presented an excellent external validation study evaluating 30 prediction models for CEA, CAS, or both and found that not a single model had C -statistic over 0.67 (poor prediction capability) during external validation proving that although there are many models to choose from none of them truly qualify for being substantially useful by clinicians [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

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Predictors of 30-Day Unplanned Readmission After Carotid Artery Stenting Using Artificial Intelligence

Amritphale

Chatterjee

et al. 2021

Adv Ther

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Predictors of 30-Day Unplanned Readmission After Carotid Artery Stenting Using Artificial Intelligence

Amritphale

Chatterjee

et al. 2021

Adv Ther

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“…54,55 Several studies have evaluated timing of revascularization in patients undergoing CAS. [56][57][58][59] There is consensus among the studies that there is significant risk of periprocedural stroke with early stenting. When compared with CEA performed during the same interval, CAS within 7 days of presentation with symptomatic carotid stenosis was associated with threefold greater periprocedural stroke risk and CAS within 14 days doubles periprocedural stroke risk.…”

Section: Timing Of Carotid Revascularizationmentioning

confidence: 99%

Carotid Revascularization: Current Practice and Future Directions

Bagley

Priest

2020

Semin intervent Radiol

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Carotid stenosis is responsible for approximately 15% of ischemic strokes. Carotid revascularization significantly decreases patients' stroke risk. Carotid endarterectomy has first-line therapy for moderate-to-severe carotid stenosis after a series of pivotal randomized controlled trials were published almost 30 years ago. Revascularization with carotid stenting has become a popular and effective alternative in a select subpopulation of patients. We review the current state of the literature regarding revascularization indications, patient selection, advantages of each revascularization approach, timing of intervention, and emerging interventional techniques, such as transcarotid artery revascularization.

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“…Several risk prediction models for the procedural hazards of CEA have been published, but their predictive performance and clinical applicability are limited. Although risk models might inform patients about the risks and benefits of CEA by applying predictors of adverse outcomes to individual patients, it remains unclear when and how procedural complications might be prevented.…”

Section: Introductionmentioning

confidence: 99%

Timing of procedural stroke and death in asymptomatic patients undergoing carotid endarterectomy: individual patient analysis from four RCTs

Poorthuis

Morris

Pan

et al. 2020

British Journal of Surgery

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Background: The effectiveness of carotid endarterectomy (CEA) for stroke prevention depends on low procedural risks. The aim of this study was to assess the frequency and timing of procedural complications after CEA, which may clarify underlying mechanisms and help inform safe discharge policies. Methods: Individual-patient data were obtained from four large carotid intervention trials (VACS, ACAS, ACST-1 and GALA; 1983-2007). Patients undergoing CEA for asymptomatic carotid artery stenosis directly after randomization were used for the present analysis. Timing of procedural death and stroke was divided into intraoperative day 0, postoperative day 0, days 1-3 and days 4-30. Results: Some 3694 patients were included in the analysis. A total of 103 patients (2⋅8 per cent) had serious procedural complications (18 fatal strokes, 68 non-fatal strokes, 11 fatal myocardial infarctions and 6 deaths from other causes) [Correction added on 20 April, after first online publication: the percentage value has been corrected to 2⋅8]. Of the 86 strokes, 67 (78 per cent) were ipsilateral, 17 (20 per cent) were contralateral and two (2 per cent) were vertebrobasilar. Forty-five strokes (52 per cent) were ischaemic, nine (10 per cent) haemorrhagic, and stroke subtype was not determined in 32 patients (37 per cent). Half of the strokes happened on the day of CEA. Of all serious complications recorded, 44 (42⋅7 per cent) occurred on day 0 (20 intraoperative, 17 postoperative, 7 with unclear timing), 23 (22⋅3 per cent) on days 1-3 and 36 (35⋅0 per cent) on days 4-30.Conclusion: At least half of the procedural strokes in this study were ischaemic and ipsilateral to the treated artery. Half of all procedural complications occurred on the day of surgery, but one-third after day 3 when many patients had been discharged.

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Prediction Models for Clinical Outcome After a Carotid Revascularization Procedure

Abstract: Supplemental Digital Content is available in the text.

Cited by 16 publications

References 23 publications

Predictors of 30-Day Unplanned Readmission After Carotid Artery Stenting Using Artificial Intelligence

Predictors of 30-Day Unplanned Readmission After Carotid Artery Stenting Using Artificial Intelligence

Carotid Revascularization: Current Practice and Future Directions

Timing of procedural stroke and death in asymptomatic patients undergoing carotid endarterectomy: individual patient analysis from four RCTs

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