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Carotid stenting and endarterectomy and contralateral carotid occlusion.

Publication ,  Journal Article
Turley, RS; Freischlag, K; Truong, T; Benrashid, E; Kuchibahtla, M; Shortell, CK; Mureebe, L
Published in: J Vasc Surg
September 2019

BACKGROUND: The presence of contralateral carotid occlusion (CCO) has been controversial throughout the history of carotid intervention. Some studies cite a higher stroke risk in the setting of CCO, whereas other studies document no difference in stroke risk. We investigated the risk of stroke after intervention in the setting of CCO in a large, national, validated dataset. METHODS: Data were obtained from the 2011-2014 American College of Surgeons National Surgical Quality Initiative Project files using targeted carotid endarterectomy (CEA), carotid angioplasty, and carotid artery stenting (CAS) data. Patient and procedural characteristics, and 30-day postoperative outcomes were compared using Pearson χ2 tests for categorical variables and Wilcoxon rank-sum tests for continuous variables. Logistic regression was used for multivariable analysis. The primary outcome measure was the stroke rate, with a secondary outcome of major adverse cardiovascular events. RESULTS: During the study period, 11,948 CEA and 422 CAS procedures were available for study, with significantly fewer CEA (4.73% of all CEA) than CAS (9.95%; P < .0001) occurring in the setting of CCO. CAS was associated with more severe degree of stenosis than CEA (P = .045). Multivariable logistic regression showed that stroke after procedures was higher in patients with CCO than without CCO (odds ratio, 1.73; 95% confidence interval, 1.08-2.76; P = .02), but specific procedure (CEA vs CAS) was not associated with stroke while controlling for confounders. However, when evaluating our secondary composite outcome, CCO was not associated with the outcome while controlling for confounders. CONCLUSIONS: There is currently a bias that CCO confers a higher risk on patients undergoing carotid procedures and this notion is manifest in the proportion of CEA and CAS procedures done in the setting of CCO. Our study observes that CCO provides only a minor influence on periprocedural stroke risk and that other factors are more closely tied to outcomes of CEA and CAS.

Duke Scholars

Published In

J Vasc Surg

DOI

EISSN

1097-6809

Publication Date

September 2019

Volume

70

Issue

3

Start / End Page

824 / 831

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Stents
  • Severity of Illness Index
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Prevalence
  • Middle Aged
 

Citation

APA
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ICMJE
MLA
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Turley, R. S., Freischlag, K., Truong, T., Benrashid, E., Kuchibahtla, M., Shortell, C. K., & Mureebe, L. (2019). Carotid stenting and endarterectomy and contralateral carotid occlusion. J Vasc Surg, 70(3), 824–831. https://doi.org/10.1016/j.jvs.2018.12.039
Turley, Ryan S., Kyle Freischlag, Tracy Truong, Ehsan Benrashid, Magaratha Kuchibahtla, Cynthia K. Shortell, and Leila Mureebe. “Carotid stenting and endarterectomy and contralateral carotid occlusion.J Vasc Surg 70, no. 3 (September 2019): 824–31. https://doi.org/10.1016/j.jvs.2018.12.039.
Turley RS, Freischlag K, Truong T, Benrashid E, Kuchibahtla M, Shortell CK, et al. Carotid stenting and endarterectomy and contralateral carotid occlusion. J Vasc Surg. 2019 Sep;70(3):824–31.
Turley, Ryan S., et al. “Carotid stenting and endarterectomy and contralateral carotid occlusion.J Vasc Surg, vol. 70, no. 3, Sept. 2019, pp. 824–31. Pubmed, doi:10.1016/j.jvs.2018.12.039.
Turley RS, Freischlag K, Truong T, Benrashid E, Kuchibahtla M, Shortell CK, Mureebe L. Carotid stenting and endarterectomy and contralateral carotid occlusion. J Vasc Surg. 2019 Sep;70(3):824–831.
Journal cover image

Published In

J Vasc Surg

DOI

EISSN

1097-6809

Publication Date

September 2019

Volume

70

Issue

3

Start / End Page

824 / 831

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Stents
  • Severity of Illness Index
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Prevalence
  • Middle Aged