Thirty-Day Outcome of Carotid Artery Stenting in Elderly Patients: A Single-Center Experience

Feng, Yao; Bai, Xuesong; Li, Shenmao; Zhu, Feiqi; Wang, Yabing; Chen, Yanfei; Gao, Peng; Yang, Bin; Yang, Hua; Lu, Jie; Li, Feng; Ma, Yan

doi:10.1016/j.wneu.2020.02.093

Cited by 5 publications

(5 citation statements)

References 39 publications

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“…Severe preoperative neurologic deficits have been linked with cerebrovascular and cerebral tissue damage, auto-regulation disorder, and reperfusion damage. 30 Yao Feng et al 31 also identified poor preoperative neurologic conditions as an independent risk factor for 30-day outcomes in CAS patients, confirming our results. To determine whether being symptomatic influences our results, we performed interaction tests between each of our confounders and symptomatic status.…”

Section: Discussionsupporting

confidence: 90%

Prognostic Value of 3 Nutritional Screening Tools to Predict 30-Day Outcome in Patients Undergoing Carotid Artery Stenting

et al. 2021

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The effect of malnutrition on outcomes after carotid artery stenting (CAS) is not well known. This study reports the relationship between malnutrition and post-procedure 30-day major adverse events (MAEs). A total of 978 patients hospitalized for CAS were enrolled in the study. Controlling nutritional status (CONUT) score, the nutritional risk index (NRI), and the prognostic nutritional index (PNI) were calculated. MAEs (myocardial infarction, stroke/transient ischemic attack and mortality) were compared. According to the CONUT score, NRI, and PNI, 9.4%, 41%, and 11.4% patients were moderately or severely malnourished, respectively; 74.8% were at least mildly malnourished by at least 1 score. Forty-seven patients (4.8%) had a post-procedure 30-day MAE. Continuous classifications of the indexes were independently associated with higher MAE. CONUT showed the highest predictive ability, whereas NRI had the lowest (C-index: CONUT, 0.701; NRI, 0.681; PNI, 0.688). According to categorical classification of indexes, only CONUT and PNI showed predictive ability for MAE. Malnutrition assessment could identify patients with CAS at elevated risk for MAE. CONUT, NRI, and PNI continuous scores were independent prognostic factors for the post-procedure 30-day MAE. According to our study, CONUT showed the highest predictive ability.

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Section: Discussionsupporting

confidence: 90%

Prognostic Value of 3 Nutritional Screening Tools to Predict 30-Day Outcome in Patients Undergoing Carotid Artery Stenting

et al. 2021

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“…This result was similar to the preliminary data of CREST lead‐in phase 10 and was further confirmed by an analysis led by Voeks et al 11 Furthermore, data from 13.086 patients undergoing CAS across 2‐year period in Germany, showed that age was strongly related with in‐hospital stroke and death 12 . On the other hand, there is a growing evidence that, in high‐volume centers with high operators' experience and after proper selection of both the patients and the appropriate technique and materials, good results can be obtained in all the patients' strata 13–17 . Usually, the worst outcomes reported in the elderly are related to the higher rate of ischemic stroke due to the distal embolization as a consequence of the catheters manipulation in the aortic arch, 18 owing the more challenging anatomy in this population.…”

Section: Discussionsupporting

confidence: 82%

“…12 On the other hand, there is a growing evidence that, in high-volume centers with high operators' experience and after proper selection of both the patients and the appropriate technique and materials, good results can be obtained in all the patients' strata. [13][14][15][16][17] Usually, the worst outcomes reported in the elderly are related to the higher rate of ischemic stroke due to the distal embolization as a consequence of the catheters manipulation in the aortic arch, 18 owing the more challenging anatomy in this population. Our study confirms the significantly higher complexity of the anatomy (type III and very calcified aortic arch) in the elderly group, but not the higher rate of ischemic stroke: the tailored approach with use of both guiding catheters along with the more flexible open cell stents, in order to overcome the tortuosities, and with the operator's skill have probably allowed to minimize the embolizations (Figure 2).…”

Section: Discussionmentioning

confidence: 99%

Characteristics and outcomes of elderly patients undergoing carotid stenting: Experience of a high‐volume interventional cardiology center

Varbella

Cerrato

Rolfo

et al. 2021

Cathet Cardio Intervent

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Background: Carotid artery stenting (CAS) is an attractive option in order to treat carotid artery stenosis. However, its safety in elderly patients is questioned. Aim of this single-center retrospective study was to assess data of elderly patients undergoing CAS, and to compare them with those of the younger (< 75 years). Methods:We collected data of 580 consecutive patients undergoing CAS between December 2007 and June 2020 and compared clinical and procedural characteristics as well as in-hospital major adverse events (MACCE) and long-term mortality between patients < 75 years and patients ≥ 75 years old.Results: There were 272 patients (46.9%) with age ≥ 75 years and 308 patients (53.1%) with age < 75 years. The median follow-up was 48 months (range 2-144).There was no significant difference about in-hospital MACCE between the two groups (4.7% in the older vs. 3.5% in the younger group, p = 0.9), but a higher rate of cerebral hemorrhage occurred in the older group (1.8% vs. = 0.3%, p = 0.07), even if not significant. Long-term mortality was significantly higher in the older group (27.9 vs. 20.1%, p = 0.027). Multivariate predictors of 12-months mortality were neurologic symptoms within 6 months (OR: 4.83; 95% CI: 2.04-11.42; p ≤ 0.001), smoking

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“…Subjects with FHS had negative screening results for thrombophilia [ 134 , 135 ]. Importantly, the presence of FHS was associated with increased risk of a cardiovascular event after carotid artery stenting in patients > 70 years of age [ 136 ] and restenosis [ 137 ] or ischemic events [ 138 ] after carotid endarterectomy.…”

Section: Resultsmentioning

confidence: 99%

Family history of stroke – a useful clue for the primary care physician and stroke neurologist: a narrative review

Błaż¹,

Sarzyńska‐Długosz²

2023

ppn

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Purpose:The heritability of ischemic stroke is a complex mechanism, involving the contribution of genetic traits and environmental factors, which is why in everyday practice clinicians often rely on the broad term "family history of stroke", defined as the case of any first-degree relative who has had a stroke. The aim of this review is to update the available data regarding family history of stroke in primary and secondary stroke prevention by searching the electronic Scopus database for the phrase TITLE-ABS-KEY ("family history" AND "stroke"). Views: A total of 140 articles met the pre-specified criteria and were included in the review. The prevalence of family history of stroke ranged from 37% in stroke-free individuals to 52% in patients with ischemic stroke. In primary prevention, family history of stroke was associated with increased risk of stroke, transient ischemic attack, stroke risk factors and stroke-like symptoms. In patients with ischemic stroke, it was more often associated with small-and large-vessel disease, though not with a cardioembolic etiology. Family history of stroke did not influence long-term functional outcomes after rehabilitation. In young stroke victims, it was related to symptom severity and the risk of a second stroke. Conclusions: Consideration of family history of stroke in everyday practice may carry useful information both for primary care physicians and stroke neurologists.

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Thirty-Day Outcome of Carotid Artery Stenting in Elderly Patients: A Single-Center Experience

Cited by 5 publications

References 39 publications

Prognostic Value of 3 Nutritional Screening Tools to Predict 30-Day Outcome in Patients Undergoing Carotid Artery Stenting

Prognostic Value of 3 Nutritional Screening Tools to Predict 30-Day Outcome in Patients Undergoing Carotid Artery Stenting

Characteristics and outcomes of elderly patients undergoing carotid stenting: Experience of a high‐volume interventional cardiology center

Family history of stroke – a useful clue for the primary care physician and stroke neurologist: a narrative review

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