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Preoperative symptom type influences the 30-day perioperative outcomes of carotid endarterectomy and carotid stenting in the Society for Vascular Surgery Vascular Registry.
J Vasc Surg. 2014 Sep; 60(3):639-44.JV

Abstract

OBJECTIVE

The objective of this study was to determine the effect of presenting symptom types on 30-day periprocedural outcomes of carotid endarterectomy (CEA) and carotid artery stenting (CAS) in contemporary vascular practice.

METHODS

Retrospective review was undertaken of the Society for Vascular Surgery Vascular Registry database subjects who underwent CEA or CAS from 2004 to 2011. Patients were grouped by discrete 12-month preprocedural ipsilateral symptom type: stroke, transient ischemic attack (TIA), transient monocular blindness (TMB), or asymptomatic (ASX). Risk-adjusted odds ratios (ORs) were used to compare the likelihood of the 30-day outcomes of death, stroke, and myocardial infarction (MI) and the composite outcomes of death + stroke and death + stroke + MI.

RESULTS

Symptom type significantly influences risk-adjusted 30-day outcomes for carotid intervention. Presentation with stroke predicted the poorest outcomes (death + stroke + MI composite: OR, 1.3; 95% confidence interval [CI], 0.83-2.03 vs TIA; OR, 2.56; 95% CI, 1.18-5.57 vs TMB; OR, 2.12; 95% CI, 1.46-3.08 vs ASX), followed by TIA (death + stroke + MI composite: OR, 1.97; 95% CI, 0.91-4.25 vs TMB; OR, 1.63; 95% CI, 1.14-2.33 vs ASX). For both CAS and CEA patients, presentation with stroke or TIA predicted a higher risk of periprocedural stroke than in ASX patients. Presentation with stroke predicted higher 30-day risk of death with CAS but not with CEA. MI rates were not affected by presenting symptom type. The 30-day outcomes for the TMB and ASX patient groups were equivalent in both treatment arms.

CONCLUSIONS

Presenting symptom type significantly affects the 30-day outcomes of both CAS and CEA in contemporary vascular surgical practice. Presentation with stroke and TIA predicts higher rates of periprocedural complications, whereas TMB presentation predicts a periprocedural risk profile similar to that of ASX disease.

Authors+Show Affiliations

Division of Surgery, Vascular Surgery Section, Washington University Medical School, St. Louis, Mo.Department of Surgery, Division of Vascular Surgery, Medical University of South Carolina, Charleston, SC.Southcoast Cardiovascular Surgery, Southcoast Health System, Fall River, Mass.Division of Vascular and Endovascular Surgery, University of Virginia Medical School, Charlottesville, Va.Department of Cardiovascular Sciences, Vascular Surgery, East Carolina University, Greenville, NC.New England Research Institutes, Inc, Watertown, Mass. Electronic address: ssiami@neriscience.com.New England Research Institutes, Inc, Watertown, Mass.Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25154963

Citation

Geraghty, Patrick J., et al. "Preoperative Symptom Type Influences the 30-day Perioperative Outcomes of Carotid Endarterectomy and Carotid Stenting in the Society for Vascular Surgery Vascular Registry." Journal of Vascular Surgery, vol. 60, no. 3, 2014, pp. 639-44.
Geraghty PJ, Brothers TE, Gillespie DL, et al. Preoperative symptom type influences the 30-day perioperative outcomes of carotid endarterectomy and carotid stenting in the Society for Vascular Surgery Vascular Registry. J Vasc Surg. 2014;60(3):639-44.
Geraghty, P. J., Brothers, T. E., Gillespie, D. L., Upchurch, G. R., Stoner, M. C., Siami, F. S., Kenwood, C. T., & Goodney, P. P. (2014). Preoperative symptom type influences the 30-day perioperative outcomes of carotid endarterectomy and carotid stenting in the Society for Vascular Surgery Vascular Registry. Journal of Vascular Surgery, 60(3), 639-44. https://doi.org/10.1016/j.jvs.2014.03.237
Geraghty PJ, et al. Preoperative Symptom Type Influences the 30-day Perioperative Outcomes of Carotid Endarterectomy and Carotid Stenting in the Society for Vascular Surgery Vascular Registry. J Vasc Surg. 2014;60(3):639-44. PubMed PMID: 25154963.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Preoperative symptom type influences the 30-day perioperative outcomes of carotid endarterectomy and carotid stenting in the Society for Vascular Surgery Vascular Registry. AU - Geraghty,Patrick J, AU - Brothers,Thomas E, AU - Gillespie,David L, AU - Upchurch,Gilbert R, AU - Stoner,Michael C, AU - Siami,Flora S, AU - Kenwood,Christopher T, AU - Goodney,Philip P, PY - 2013/12/11/received PY - 2014/03/11/accepted PY - 2014/8/27/entrez PY - 2014/8/27/pubmed PY - 2014/11/7/medline SP - 639 EP - 44 JF - Journal of vascular surgery JO - J. Vasc. Surg. VL - 60 IS - 3 N2 - OBJECTIVE: The objective of this study was to determine the effect of presenting symptom types on 30-day periprocedural outcomes of carotid endarterectomy (CEA) and carotid artery stenting (CAS) in contemporary vascular practice. METHODS: Retrospective review was undertaken of the Society for Vascular Surgery Vascular Registry database subjects who underwent CEA or CAS from 2004 to 2011. Patients were grouped by discrete 12-month preprocedural ipsilateral symptom type: stroke, transient ischemic attack (TIA), transient monocular blindness (TMB), or asymptomatic (ASX). Risk-adjusted odds ratios (ORs) were used to compare the likelihood of the 30-day outcomes of death, stroke, and myocardial infarction (MI) and the composite outcomes of death + stroke and death + stroke + MI. RESULTS: Symptom type significantly influences risk-adjusted 30-day outcomes for carotid intervention. Presentation with stroke predicted the poorest outcomes (death + stroke + MI composite: OR, 1.3; 95% confidence interval [CI], 0.83-2.03 vs TIA; OR, 2.56; 95% CI, 1.18-5.57 vs TMB; OR, 2.12; 95% CI, 1.46-3.08 vs ASX), followed by TIA (death + stroke + MI composite: OR, 1.97; 95% CI, 0.91-4.25 vs TMB; OR, 1.63; 95% CI, 1.14-2.33 vs ASX). For both CAS and CEA patients, presentation with stroke or TIA predicted a higher risk of periprocedural stroke than in ASX patients. Presentation with stroke predicted higher 30-day risk of death with CAS but not with CEA. MI rates were not affected by presenting symptom type. The 30-day outcomes for the TMB and ASX patient groups were equivalent in both treatment arms. CONCLUSIONS: Presenting symptom type significantly affects the 30-day outcomes of both CAS and CEA in contemporary vascular surgical practice. Presentation with stroke and TIA predicts higher rates of periprocedural complications, whereas TMB presentation predicts a periprocedural risk profile similar to that of ASX disease. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/25154963/Preoperative_symptom_type_influences_the_30_day_perioperative_outcomes_of_carotid_endarterectomy_and_carotid_stenting_in_the_Society_for_Vascular_Surgery_Vascular_Registry_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(14)00615-6 DB - PRIME DP - Unbound Medicine ER -