دورية أكاديمية
Determinants of Mortality and Mid-Term Outcomes After Transcarotid Artery Revascularization and Transfemoral Carotid Artery Stenting.
| العنوان: | Determinants of Mortality and Mid-Term Outcomes After Transcarotid Artery Revascularization and Transfemoral Carotid Artery Stenting. |
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| المؤلفون: | Zhu J; Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Rao A; Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Berger K; Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Gopal M; Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Vrudhula A; Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Han D; Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Vouyouka A; Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Ting W; Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Finlay D; Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Kim SY; Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Tadros R; Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Marin M; Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Faries P; Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA. |
| المصدر: | Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists [J Endovasc Ther] 2024 Mar 06, pp. 15266028241235791. Date of Electronic Publication: 2024 Mar 06. |
| Publication Model: | Ahead of Print |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Sage Publications Country of Publication: United States NLM ID: 100896915 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1545-1550 (Electronic) Linking ISSN: 15266028 NLM ISO Abbreviation: J Endovasc Ther Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2015- : Thousand Oaks, CA : Sage Publications Original Publication: Phoenix, AZ : The Society, c2000- |
| مستخلص: | Objectives: The potential benefit of transcarotid artery revascularization (TCAR) over transfemoral carotid artery stenting (tfCAS) has been studied in the perioperative period with lower rates of stroke and death; however, data on mid-term outcomes are limited. We aimed to evaluate 3-year outcomes after TCAR and tfCAS and determine the primary predictors of 30-day and 1-year mortality following TCAR. Methods: Data from the Vascular Quality Initiative for patients undergoing TCAR or tfCAS from January 2016 to December 2022 were analyzed. 1:1 propensity score matching using the nearest-neighbor method was used to adjust baseline demographics and clinical characteristics. Kaplan-Meier survival analysis and Cox Proportional Hazard Regression were used to evaluate long-term outcomes. Iterative stepwise multiple logistic regression analysis and Cox Proportional Hazard Regression were used to identify predictors of 30-day and 1-year mortality, respectively, based upon preoperative, intraoperative, and postoperative factors. Results: A total of 70 237 patients were included in analysis (TCAR=58.7%, tfCAS=41.3%). Transcarotid artery revascularization patients were older and had higher rates of comorbid conditions and high-risk medical and anatomic features than tfCAS patients. Propensity score matching yielded 22 322 pairs with no major differences between groups except that TCAR patients were older (71.6 years vs 70.8 years). At 3 years, TCAR was associated with a 24% reduction in hazard of death compared with tfCAS (hazard ratio [HR]=0.76, 95% confidence interval [CI]=0.71-0.82, p<0.001), for both symptomatic and asymptomatic patients. This survival advantage was established in the first 6 months (HR=0.59, 95% CI=0.53-0.62, p<0.001), with no difference in mortality risk from 6 months to 36 months (HR=0.95, 95% CI=0.86-1.05, p=0.31). Transcarotid artery revascularization was also associated with decreased hazard for 3-year stroke (HR=0.81, 95% CI=0.66-0.99, p=0.04) and stroke or death (HR=0.81, 95% CI=0.76-0.87, p<0.001) compared with tfCAS. The top predictors for 30-day and 1-year mortality were postoperative complications. The primary independent predictor was the occurrence of postoperative stroke. Conclusions: Transcarotid artery revascularization had a sustained mid-term survival advantage associated over tfCAS, with the benefit being established primarily within the first 6 months. Notably, our findings highlight the importance of postoperative stroke as the primary independent predictor for 30-day and 1-year mortal. Clinical Impact: The ongoing debate over the superiority of TCAR compared to tfCAS and CEA has been limited by a lack of comparative studies examining the impact of pre-operative symptoms on outcomes. Furthermore, data are scarce on mid-term outcomes for TCAR beyond the perioperative period. As a result, it remains uncertain whether the initial benefits of stroke and death reduction observed with TCAR over tfCAS persist beyond one year. Our study addresses these gaps in the literature, offering evidence to enable clinicians to assess the efficacy of TCAR for up to three years. Additionally, our study seeks to identify risk factors for postoperative mortality following TCAR, facilitating optimal patient stratification. Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. |
| فهرسة مساهمة: | Keywords: carotid stent/stenting; common carotid artery; embolic protection; endovascular treatment/therapy; flow-diverting stent/technology |
| تواريخ الأحداث: | Date Created: 20240307 Latest Revision: 20240307 |
| رمز التحديث: | 20240307 |
| DOI: | 10.1177/15266028241235791 |
| PMID: | 38449352 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1545-1550 |
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| DOI: | 10.1177/15266028241235791 |