دورية أكاديمية
أعرض في EDS

Carotid stenosis patients with a remote history of cerebrovascular events have increased risk of major adverse events over asymptomatic patients.

التفاصيل البيبلوغرافية
العنوان: Carotid stenosis patients with a remote history of cerebrovascular events have increased risk of major adverse events over asymptomatic patients.
المؤلفون: Turner AD; Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: Anthony.Turner@mountsinai.orgr., Zhu J; Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY., 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., Vouyouka A; 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., 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: Journal of vascular surgery [J Vasc Surg] 2022 Dec; Vol. 76 (6), pp. 1625-1632. Date of Electronic Publication: 2022 Jul 19.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Elsevier Country of Publication: United States NLM ID: 8407742 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1097-6809 (Electronic) Linking ISSN: 07415214 NLM ISO Abbreviation: J Vasc Surg Subsets: MEDLINE
أسماء مطبوعة: Publication: <2008-> : New York, NY : Elsevier
Original Publication: St. Louis, Mo. : Mosby, [c1984-
مواضيع طبية MeSH: Carotid Stenosis*/complications , Carotid Stenosis*/diagnostic imaging , Carotid Stenosis*/therapy , Stroke*/etiology , Myocardial Infarction*/etiology , Endovascular Procedures*/adverse effects, Humans ; Male ; Female ; Aged ; Stents/adverse effects ; Hospital Mortality ; Risk Factors ; Treatment Outcome ; Risk Assessment ; Retrospective Studies
مستخلص: Introduction: Asymptomatic patients with a remote history of transient ischemic attack (TIA) or stroke are not well studied as a separate population from asymptomatic patients with no prior history of TIA or stroke. We compared in-hospital outcomes after transcarotid artery revascularization (TCAR) and transfemoral carotid artery stenting (TFCAS) among symptomatic patients, patients with a remote history of neurologic symptoms, and asymptomatic patients.
Methods: Data from patients in the Vascular Quality Initiative database who underwent TCAR (January 2017 to April 2020) or TFCAS (May 2005 to April 2020) were analyzed. Symptomatic status was defined as TIA and/or stroke occurring within 180 days before the procedure. Asymptomatic status was divided into patients with no history of TIA/stroke (asymptomatic) and patients with a history of TIA/stroke occurring more than 180 days before the procedure (remote history of neurologic symptoms). The Student t-test and Pearson χ 2 test were used to compare baseline patient characteristics and outcomes. Multivariate logistic regression was used to adjust for significant between-group differences in baseline characteristics.
Results: There were 7158 patients who underwent TCAR (symptomatic: 2574, asymptomatic: 3689, and asymptomatic with a remote history of neurologic symptoms: 895) and 18,023 patients who underwent TFCAS (symptomatic: 6195, asymptomatic: 10,333, and asymptomatic with a remote history of neurologic symptoms: 1495). Regardless of symptom status, the mean patient age was 73 years for TCAR and 69 years for TFCAS. A total of 64% of patients in the study were male and 36% of patients were female. The mean long-term follow-up data ranged between 208 and 331 days within the three patient groups. Carotid stenosis patients with a remote history of neurologic symptoms had higher rates of TIA, stroke, TIA/stroke, stroke/death, and stroke/death/myocardial infarction than asymptomatic patients, and these rates were similar to those of symptomatic patients. Comparing TCAR and TFCAS among patients with a remote history of neurologic symptoms, there were statistically significant reductions in the odds of stroke/death (odds ratio: 0.46, 95% confidence interval: 0.27-0.84, P = .011) and stroke/death/myocardial infarction (odds ratio: 0.51, 95% confidence interval: 0.30-0.87, P = .013) after TCAR. This was likely driven by the increased rate of death after TFCAS in patients with a remote history of neurologic symptoms (0.9%) compared with asymptomatic patients (0.6%).
Conclusions: Asymptomatic patients with a remote history of TIA/stroke do not have the same outcomes as asymptomatic patients without a history of TIA/stroke and are at higher risk of adverse in-hospital events. Patients with a remote history of TIA/stroke have increased risk of in-hospital death after TFCAS and may benefit from TCAR.
(Copyright © 2022 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
التعليقات: Comment in: J Vasc Surg. 2022 Dec;76(6):1633. (PMID: 36410847)
فهرسة مساهمة: Keywords: Carotid artery disease; Carotid artery stenosis; Cerebrovascular events; Transcarotid artery revascularization; Transfemoral carotid artery stenting
تواريخ الأحداث: Date Created: 20220722 Date Completed: 20221123 Latest Revision: 20221221
رمز التحديث: 20240628
DOI: 10.1016/j.jvs.2022.07.013
PMID: 35868422
قاعدة البيانات: MEDLINE
الوصف
تدمد:1097-6809
DOI:10.1016/j.jvs.2022.07.013