دورية أكاديمية
Comparison of Transcarotid Artery Revascularization and Transfemoral Carotid Artery Stenting Based on High Risk Anatomic Characteristics.
| العنوان: | Comparison of Transcarotid Artery Revascularization and Transfemoral Carotid Artery Stenting Based on High Risk Anatomic Characteristics. |
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| المؤلفون: | Zhu J; Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: Jerry.Zhu@icahn.mssm.edu., Rao A; Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY., Ting W; Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY., Han D; Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY., Tadros R; Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY., Finlay D; Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY., Phair J; Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY., Vouyouka A; Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY., Liu H; Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY., Marin M; Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY., Faries P; Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY. |
| المصدر: | Annals of vascular surgery [Ann Vasc Surg] 2022 Nov; Vol. 87, pp. 21-30. Date of Electronic Publication: 2022 Apr 06. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Country of Publication: Netherlands NLM ID: 8703941 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1615-5947 (Electronic) Linking ISSN: 08905096 NLM ISO Abbreviation: Ann Vasc Surg Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: <2007->: Netherlands : Elsevier Original Publication: Detroit : [Published by Expansion scientifique française for Annals of Vascular Surgery, Inc. and Association pour la promotion de la chirurgie vasculaire, Paris, c1986- |
| مواضيع طبية MeSH: | Carotid Stenosis*/complications , Carotid Stenosis*/diagnostic imaging , Carotid Stenosis*/therapy , Endovascular Procedures*/adverse effects , Stroke* , Myocardial Infarction*/etiology, Humans ; Stents/adverse effects ; Risk Assessment ; Treatment Outcome ; Retrospective Studies ; Risk Factors ; Femoral Artery/diagnostic imaging ; Carotid Arteries |
| مستخلص: | Background: Anatomic details affecting the adverse outcomes following carotid artery stenting have not been well characterized. We compared in-hospital outcomes following transcarotid artery revascularization (TCAR) and transfemoral carotid artery stenting (TFCAS) among symptomatic and asymptomatic patients stratified by degree of lesion calcification and aortic arch type. Methods: Data from patients in the Society for Vascular Surgery's Vascular Quality Initiative database undergoing TCAR (January 2017 to April 2020) or TFCAS (May 2005 to April 2020) and had non-missing grading on carotid artery calcification or aortic arch type was analyzed. Degree of calcification was stratified into 3 groups: none, ≤ 50% calcification, and >50% calcification. Arch type was stratified as Type I, Type II, and Type III. Results: A total of 9,868 patients (TCAR: 4,224; TFCAS: 5,644) were included in the calcification analysis. TCAR patients were generally older, white, smokers, and had more comorbidities than TFCAS patients. Among the symptomatic patients, there was no difference in rates of stroke, stroke/transient ischemic attack (TIA), and myocardial infarction (MI) by calcification severity between TCAR and TFCAS. However, there was a trend towards increased risk in all 3 events with higher calcification only after TFCAS. Symptomatic patients with severe (>50%) calcification had lower rates of death (TCAR: 0.9% vs. TFCAS: 2.8%, P = 0.013), stroke/death (TCAR: 2.7% vs. TFCAS: 5.8%, P = 0.006), stroke/death/MI (TCAR: 3.3% vs. TFCAS: 6.5%, P = 0.007), and postop complications (TCAR: 6.0% vs. TFCAS: 12.4%, P < 0.001) after TCAR compared to TFCAS. Furthermore, TCAR had lower risk of mortality at all degrees of calcification compared to TFCAS. Similar findings were noted among asymptomatic TCAR patients with >50% calcification, in which the rates of death (TCAR: 0.4% vs. TFCAS: 1.1%, P = 0.080) and stroke/death (TCAR: 1.5% vs. TFCAS: 3.1%, P = 0.029) were reduced. A comparison of TCAR to TFCAS by arch type showed that rates of stroke/death after TCAR were similar regardless of arch complexity (Type I: 2.6% vs. Type II: 2.8%), but increased after TFCAS with complex, high risk anatomy (Type I: 4.2% vs. Type II: 5.2%). Conclusions: While increased calcification increased rates of adverse events after TFCAS, this trend was not observed after TCAR, which also had lower rates of death and stroke/death among patients with severe calcification. Furthermore, TCAR had lower risk of mortality than TFCAS across all degrees of calcification. TFCAS was associated with increased risk of stroke/death with complex aortic arch anatomy, however, rates of stroke/death after TCAR were similar regardless of arch complexity. Our results suggests that TCAR should be preferentially considered in revascularization of patients with anatomy considered high-risk for TFCAS. (Copyright © 2022 Elsevier Inc. All rights reserved.) |
| تواريخ الأحداث: | Date Created: 20220410 Date Completed: 20221207 Latest Revision: 20221207 |
| رمز التحديث: | 20221213 |
| DOI: | 10.1016/j.avsg.2022.03.034 |
| PMID: | 35398198 |
| قاعدة البيانات: | MEDLINE |
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Full Text Finder | تدمد: | 1615-5947 |
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| DOI: | 10.1016/j.avsg.2022.03.034 |