Results of carotid endarterectomy with prospective neurologist follow-up

Aggarwal, Rajesh; Murugappan, A.

doi:10.1212/wnl.55.6.769

Cited by 71 publications

(37 citation statements)

References 21 publications

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“…Second, some studies note that there is a tendency for self-reporting of complication rates to result in underreporting. 32,33 If reporting of perioperative strokes occurred disproportionately by specialty or processes of care, the results of this study could be inaccurate. However, it should be noted that the ORs for specialty and processes of care did not change substantially when mortality was used as the sole adverse outcome, and we were able to confirm the accuracy of mortality using the state administrative database.…”

Section: Discussionmentioning

confidence: 93%

Association of Surgical Specialty and Processes of Care With Patient Outcomes for Carotid Endarterectomy

Hannan

Popp

Feustel

et al. 2001

Stroke

120

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Background and Purpose-Because there is considerable variation in practice patterns and outcomes for carotid endarterectomy (CE), there is a need to study the processes of care that are associated with adverse outcomes. The purpose of this study was to examine the impact of processes of care and surgical specialty on adverse outcomes for CE. Methods-A retrospective cohort study based on a voluntary CE registry containing 3644 patients undergoing CE between April 1, 1997, and March 31, 1999, in New York hospitals was used in the study. A multivariable statistical model was used to identify significant independent patient risk factors and to examine the association of processes of care and surgical specialty with outcomes after adjustment for differences in patient risk factors. Results-The overall adverse outcome (in-hospital death or stroke) rate was 1.84%. After adjustment for differences in 7 patient risk factors that were significantly related to adverse outcomes, the use of Ն1 specific processes of care (eversion endarterectomy, protamine, or shunts) was found to be associated with lower odds of an adverse outcome relative to patients undergoing CE without the processes (ORϭ0. 42, Pϭ0.006). Similarly, patients undergoing surgery performed by vascular surgeons had lower odds of experiencing an adverse outcome (ORϭ0.36, Pϭ0.009). Processes of care and surgical specialty were highly correlated with one another. Conclusions-Processes of care and surgical specialty are significant interrelated determinants of adverse outcome for CE.

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Section: Discussionmentioning

confidence: 93%

Association of Surgical Specialty and Processes of Care With Patient Outcomes for Carotid Endarterectomy

Hannan

Popp

Feustel

et al. 2001

Stroke

120

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“…At least 2 analyses 18,19 have confirmed the need for prospective neurological evaluation before and after CEA to best estimate outcomes, with a 3-fold increase in events with neurology assessment compared with outcomes that were otherwise self-reported; this is especially relevant because the NASCET and ACAS trials used such evaluations and are the basis for the AHA guidelines. It is also noteworthy that in the original CAPTURE study, 11 CEAC adjudication resulted in the identification of Ϸ50% more 30-day adverse outcomes events compared with site reporting of events alone, thus confirming the importance of both prospective data gathering and the adjudication process in providing full reporting of the outcomes.…”

Section: Discussionmentioning

confidence: 99%

Thirty-Day Outcomes for Carotid Artery Stenting in 6320 Patients From 2 Prospective, Multicenter, High-Surgical-Risk Registries

Gray

Chaturvedi

Verta

2009

Circ: Cardiovascular Interventions

124

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on behalf of the Investigators and the Executive CommitteesBackground-The American Heart Association has established guidelines for acceptable 30-day death and stroke rates for patients with severe carotid disease undergoing standard-risk carotid endarterectomy: Ͻ3% for asymptomatic lesions and Ͻ6% for symptomatic lesions. To date, carotid artery stenting has not demonstrated these outcomes in multicenter, prospective assessments of high-surgical-risk patients. Methods and Results-Data from 2 prospective, multicenter (280 US sites, 672 operators), postmarket surveillance studies in high-surgical-risk patients were analyzed: 2145 patients from the Emboshield and Xact Post Approval Carotid Stent Trial (EX) and 4175 patients from the Carotid ACCULINK/ACCUNET Post Approval Trial to Uncover Rare Events (C2). Both studies had pre-and postprocedure neurological evaluation and independent adjudication of neurological events. The overall 30-day death and stroke rate was 4.1% (95% CI, 3.3% to 5.0%) for EX and 3.4% (95% CI, 2.9% to 4.0%) for C2. In the population comparable with American Heart Association guidelines (Ͻ80 years), the combined 30-day death and stroke rate was 5.3% (95% CI, 3.6% to 7.4%) for symptomatic patients and 2.9% (95% CI, 2.4% to 3.4%) for asymptomatic patients, independent of unfavorable risk factors (anatomic or physiologic); in patients Ն80 years, this rate was 10.5% (95% CI, 6.3% to 16.0%) and 4.4% (95% CI, 3.3% to 5.7%), respectively. In subjects with anatomic features unfavorable for surgery, the 30-day death and stroke rates were 1.7% (95% CI, 0.0% to 8.9%) and 2.7% (95% CI, 1.3% to 4.9%) for symptomatic and asymptomatic cohorts, respectively, independent of age. Conclusions-Outcomes

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“…It is also possible that single center series are less accurate than an administrative database in reporting their own outcomes, a phenomenon demonstrated in the carotid endarterectomy literature where adverse event rates are significantly lower when assessed by the treating surgeon than when assessed by a neurologist. 16,17 Overall use of clipping as compared with coiling of unruptured aneurysms has shown a steady decline from 2008 to 2011. The fraction of unruptured aneurysms treated by coiling in the Nationwide Inpatient Sample (NIS) increased from 11% in 1998 18 to 55.8% in 2007.…”

Section: Discussionmentioning

confidence: 99%

Comparative Effectiveness of Unruptured Cerebral Aneurysm Therapies

McDonald

Fan

et al. 2013

Stroke

105

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Background and Purpose-Endovascular therapy has increasingly become the most common treatment for unruptured cerebral aneurysms in the United States. We evaluated a national, multi-hospital database to examine recent utilization trends and compare periprocedural outcomes between clipping and coiling treatments of unruptured aneurysms. Methods-The Premier Perspective database was used to identify patients hospitalized between 2006 to 2011 for unruptured cerebral aneurysm who underwent clipping or coiling therapy. A logistic propensity score was generated for each patient using relevant patient, procedure, and hospital variables, representing the probability of receiving clipping. Covariate balance was assessed using conditional logistic regression. Following propensity score adjustment using 1:1 matching methods, the risk of in-hospital mortality and morbidity was compared between clipping and coiling cohorts.

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Results of carotid endarterectomy with prospective neurologist follow-up

Cited by 71 publications

References 21 publications

Association of Surgical Specialty and Processes of Care With Patient Outcomes for Carotid Endarterectomy

Association of Surgical Specialty and Processes of Care With Patient Outcomes for Carotid Endarterectomy

Thirty-Day Outcomes for Carotid Artery Stenting in 6320 Patients From 2 Prospective, Multicenter, High-Surgical-Risk Registries

Comparative Effectiveness of Unruptured Cerebral Aneurysm Therapies

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