Early carotid angioplasty and stenting may offer non-inferior treatment for symptomatic cases of carotid artery stenosis

Michael M. Wach, Travis M Dumont, Maxim Mokin, Tareq Kass-Hout, Kenneth V. Snyder, L. Nelson Hopkins, Elad I. Levy, Adnan H. Siddiqui

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Objective: Early intervention is desirable in patients presenting with stroke or transient ischemic attack (TIA) referable to carotid artery stenosis because of the high incidence of recurrent ischemic events within 48 h postictus. However, the optimal timing of performing carotid angioplasty and stenting (CAS) in these patients remains unclear amid concerns for an elevated risk of perioperative complications. The primary outcome of this study was the combined incidence of major perioperative complications (stroke, myocardial infarction (MI), death) based on timing of CAS relative to symptom onset. Methods: A prospectively maintained database of all neuroendovascular procedures at our hospital was searched for consecutive cases of extracranial internal CAS procedures performed for symptomatic atherosclerotic carotid stenosis between January 2009 and January 2012. Rates of perioperative complications including 30-day stroke, MI and death were assembled in a total of 221 patients. Results: The primary outcome was not statistically different among groups stratified based on intervention timing, with a combined incidence of stroke, MI or death of 7.1% in patients treated within 2 days, 4.5% in patients treated between days 3 and 7, 2.8% in patients treated between days 8 and 14 and 3.7% in patients treated between days 15 and 90 (p=0.749, Fisher exact test). Conclusions: Our results support the conclusion that early CAS (within 2 days) carries no additional risks compared with CAS after 2 days or any other timing of the intervention up to 90 days. Early CAS may represent a reasonable option for acute revascularization to minimize the risk of perioperative stroke and overall perioperative complications.

Original languageEnglish (US)
Pages (from-to)276-280
Number of pages5
JournalJournal of NeuroInterventional Surgery
Volume6
Issue number4
DOIs
StatePublished - 2014
Externally publishedYes

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Carotid Stenosis
Angioplasty
Stroke
Myocardial Infarction
Therapeutics
Incidence
Transient Ischemic Attack
Outcome Assessment (Health Care)
Databases

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology
  • Medicine(all)

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Early carotid angioplasty and stenting may offer non-inferior treatment for symptomatic cases of carotid artery stenosis. / Wach, Michael M.; Dumont, Travis M; Mokin, Maxim; Kass-Hout, Tareq; Snyder, Kenneth V.; Hopkins, L. Nelson; Levy, Elad I.; Siddiqui, Adnan H.

In: Journal of NeuroInterventional Surgery, Vol. 6, No. 4, 2014, p. 276-280.

Research output: Contribution to journalArticle

Wach, Michael M. ; Dumont, Travis M ; Mokin, Maxim ; Kass-Hout, Tareq ; Snyder, Kenneth V. ; Hopkins, L. Nelson ; Levy, Elad I. ; Siddiqui, Adnan H. / Early carotid angioplasty and stenting may offer non-inferior treatment for symptomatic cases of carotid artery stenosis. In: Journal of NeuroInterventional Surgery. 2014 ; Vol. 6, No. 4. pp. 276-280.
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abstract = "Objective: Early intervention is desirable in patients presenting with stroke or transient ischemic attack (TIA) referable to carotid artery stenosis because of the high incidence of recurrent ischemic events within 48 h postictus. However, the optimal timing of performing carotid angioplasty and stenting (CAS) in these patients remains unclear amid concerns for an elevated risk of perioperative complications. The primary outcome of this study was the combined incidence of major perioperative complications (stroke, myocardial infarction (MI), death) based on timing of CAS relative to symptom onset. Methods: A prospectively maintained database of all neuroendovascular procedures at our hospital was searched for consecutive cases of extracranial internal CAS procedures performed for symptomatic atherosclerotic carotid stenosis between January 2009 and January 2012. Rates of perioperative complications including 30-day stroke, MI and death were assembled in a total of 221 patients. Results: The primary outcome was not statistically different among groups stratified based on intervention timing, with a combined incidence of stroke, MI or death of 7.1{\%} in patients treated within 2 days, 4.5{\%} in patients treated between days 3 and 7, 2.8{\%} in patients treated between days 8 and 14 and 3.7{\%} in patients treated between days 15 and 90 (p=0.749, Fisher exact test). Conclusions: Our results support the conclusion that early CAS (within 2 days) carries no additional risks compared with CAS after 2 days or any other timing of the intervention up to 90 days. Early CAS may represent a reasonable option for acute revascularization to minimize the risk of perioperative stroke and overall perioperative complications.",
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AU - Dumont, Travis M

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AU - Snyder, Kenneth V.

AU - Hopkins, L. Nelson

AU - Levy, Elad I.

AU - Siddiqui, Adnan H.

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N2 - Objective: Early intervention is desirable in patients presenting with stroke or transient ischemic attack (TIA) referable to carotid artery stenosis because of the high incidence of recurrent ischemic events within 48 h postictus. However, the optimal timing of performing carotid angioplasty and stenting (CAS) in these patients remains unclear amid concerns for an elevated risk of perioperative complications. The primary outcome of this study was the combined incidence of major perioperative complications (stroke, myocardial infarction (MI), death) based on timing of CAS relative to symptom onset. Methods: A prospectively maintained database of all neuroendovascular procedures at our hospital was searched for consecutive cases of extracranial internal CAS procedures performed for symptomatic atherosclerotic carotid stenosis between January 2009 and January 2012. Rates of perioperative complications including 30-day stroke, MI and death were assembled in a total of 221 patients. Results: The primary outcome was not statistically different among groups stratified based on intervention timing, with a combined incidence of stroke, MI or death of 7.1% in patients treated within 2 days, 4.5% in patients treated between days 3 and 7, 2.8% in patients treated between days 8 and 14 and 3.7% in patients treated between days 15 and 90 (p=0.749, Fisher exact test). Conclusions: Our results support the conclusion that early CAS (within 2 days) carries no additional risks compared with CAS after 2 days or any other timing of the intervention up to 90 days. Early CAS may represent a reasonable option for acute revascularization to minimize the risk of perioperative stroke and overall perioperative complications.

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