Restenosis after Carotid Interventions and Its Relationship with Recurrent Ipsilateral Stroke: A Systematic Review and Meta-analysis

Kumar, R.; Batchelder, Andrew; Saratzis, Athanasios; AbuRahma, Ali F.; Ringleb, Peter A.; Lal, Brajesh K.; Mas, Jean‐Louis; Steinbauer, Markus; Naylor, A.R.

doi:10.1016/j.ejvs.2017.02.016

Cited by 85 publications

(69 citation statements)

References 29 publications

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“…Even for patients with a history of cardiovascular surgeries, therapy compliance was still unimproved (Halle et al, 2018).We assume that they may be unaware of, and underestimate the importance of, controlling risk factors to reduce stroke incidence (O'Donnell et al, 2016;Soroush et al, 2017). Considering the high prevalence of underlying diseases, it is necessary for cardiovascular surgeons to educate patients that surgery alone does not remove risk of vascular events and that continuous and good control of risk factors is vital to decrease postoperative stroke risk (Hobeanu et al, 2017;Kumar et al, 2017;O'Donnell et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular surgery experience does not significantly improve patients' response to stroke

Anderson

Gao

et al. 2019

Brain and Behavior

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Objectives Patients with a history of cardiovascular surgery are at risk of stroke, and immediately calling emergency medical services (EMS) after stroke onset is crucial to receiving effective reperfusion therapy. We aimed to determine the effect of a history of cardiovascular surgery on patients' ability to recognize stroke and intent to call EMS. Methods We performed a cross‐sectional community‐based study from January 2017 to May 2017. A total population of 186,167 individuals, recruited from 69 administrative areas across China, was analyzed. Different multivariable logistic regression models were performed to identify the associations between cardiovascular surgical history and stroke recognition or intent to call EMS, respectively. Results 0.1% of the total population had a history of cardiovascular surgery. In the surgery group, the estimated stroke recognition rate (SRR) and correct action rate (CAR) were 84.9% and 74.7%, respectively. The prevalence of cardiovascular risk factors was significantly higher in the surgery group. Cardiovascular surgical history was not associated with recognition of stroke across different models. The surgery group was more likely to call EMS, but the difference was not significant after full adjustment (OR: 1.40, 95% CI: 0.99–1.98, p = .0572). Conclusions Cardiovascular surgical history does not influence patients' likelihood of calling EMS more often at stroke onset. Patients receiving cardiovascular surgeries should be counseled regarding stroke recognition, proper response to stroke, and the importance of controlling risk factors.

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Section: Discussionmentioning

confidence: 99%

Cardiovascular surgery experience does not significantly improve patients' response to stroke

Anderson

Gao

et al. 2019

Brain and Behavior

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“…A meta-analysis of 5 randomized controlled trials including 2716 patients and covering a median follow-up of 62 months concluded that there may be a relationship between in-stent restenosis and stroke recurrence after CAS, and the incidence of restenosis with blockage > 70% was 10% [22]. In our study, only 2 of the 72 patients followed up at the outpatient clinic had in-stent restenosis with blockage > 50%, and there was no significant difference between the two groups (<70 vs. ≥70 years at surgery) (Table 2).…”

Section: Discussionmentioning

confidence: 99%

The Long-Term Efficacy and Safety of Carotid Artery Stenting among the Elderly: A Single-Center Study in China

Wen

Liu

Chen

et al. 2018

Behavioural Neurology

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Compared to carotid endarterectomy, carotid artery stenting (CAS) is reportedly associated with higher perioperative risks in elderly patients. To verify the long-term safety and efficacy of CAS with embolic protection in elderly patients, we retrospectively reviewed the medical records of patients with carotid stenosis treated between January 2003 and March 2010 at the Department of Neurology of a large university hospital in China. We included patients with symptomatic, moderate, or severe carotid stenosis of atherosclerotic etiology (other etiologies were excluded), with a disability score ≤ 3 on the modified Rankin Scale, and who received CAS instead of carotid endarterectomy. The clinical endpoints studied were stroke recurrence and all-cause death. The 84 patients included in this study (median follow-up, 8.08 years) were stratified according to age at surgery (<70 vs. ≥70 years), and no significant between-group difference was found regarding baseline characteristics. Of the 14 patients (16.67%) who experienced a defined clinical endpoint, 4 (7.14%) were aged <70 years and 10 (35.71%) were aged ≥70 years (P = 0.002). Overall mortality was 14.29% (12/84), with 3 (5.36%) and 9 (32.14%) deaths among patients aged <70 and ≥ 70 years, respectively (P = 0.002). Heart disease and cancer accounted for most deaths. The two groups did not differ regarding stroke recurrence, disability score, or rate of in-stent restenosis (blockage ≥ 50%), but patients aged ≥70 years had a higher risk of mortality (odds ratio, 8.3684; 95% confidence interval, 2.048–34.202; P = 0.003), and age was an independent risk factor for death (odds ratio, 20.054; 95% confidence interval, 3.094–129.987, P = 0.002). Among elderly patients in Southwest China, CAS can effectively prevent stroke recurrence without increasing the risk of stroke-related death, but the risk of all-cause death is higher, with age as an independent risk factor. Careful patient selection is of key importance in the treatment of symptomatic carotid artery stenosis.

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“…Cases of moderate and severe symptomatic restenosis and severe asymptomatic restenosis continue to be operated on; although the effectiveness of treating asymptomatic patients is debatable, 20 there is a well established relationship between restenosis and late ipsilateral stroke, 21 particularly when progression occurs. 1,22 Also the recent guidelines of the European Society for Vascular Surgery (ESVS) recommend, with a B level of evidence, intervention in patients with severe asymptomatic restenosis, provided that an accurate multidisciplinary evaluation is performed.…”

Section: Discussionmentioning

confidence: 99%

A Propensity Matched Comparison for Open and Endovascular Treatment of Post-carotid Endarterectomy Restenosis

Dorigo

Fargion

Giacomelli

et al. 2018

European Journal of Vascular and Endovascular Surgery

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Restenosis after Carotid Interventions and Its Relationship with Recurrent Ipsilateral Stroke: A Systematic Review and Meta-analysis

Cited by 85 publications

References 29 publications

Cardiovascular surgery experience does not significantly improve patients' response to stroke

Cardiovascular surgery experience does not significantly improve patients' response to stroke

The Long-Term Efficacy and Safety of Carotid Artery Stenting among the Elderly: A Single-Center Study in China

A Propensity Matched Comparison for Open and Endovascular Treatment of Post-carotid Endarterectomy Restenosis

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