Outcomes of Primary and Secondary Carotid Artery Stenting

Isibor J. Arhuidese, Muhammad Rizwan, Besma Nejim, Mahmoud Malas

Research output: Contribution to journalArticle

Abstract

BACKGROUND AND PURPOSE: Little is known of the excess risk attributable to secondary carotid angioplasty and stenting (CAS). This study evaluates outcomes of redo-CAS and CAS after prior ipsilateral carotid endarterectomy (CASAPICEA) relative to primary-CAS.

METHODS: We studied all patients in the Vascular Quality Initiative, who underwent primary-CAS, CASAPICEA, or redo-CAS (2003-2016). Kaplan-Meier, multivariable logistic and Cox regression analyses were used to evaluate outcomes within 30 days and up to 1 year and identify their predictors.

RESULTS: There were 11 742 CAS procedures performed: 8519 (72%) primary-, 2645 (23%) CASAPICEA, and 578 (5%) redo-CAS. Comparing primary-CAS versus CASAPICEA versus redo-CAS, 30-day stroke/death was 2.5% versus 2.0% versus 1.3% for asymptomatic patients (P=0.23) and 5.2% versus 2.6% versus 5.0% for symptomatic patients (P=0.003). CASAPICEA was associated with significantly lower 30-day stroke/death (odds ratio: 0.60; 95% confidence interval: 0.37-0.98; P=0.04) compared with primary-CAS among symptomatic patients. The odds of bradycardia were lower following CASAPICEA (odds ratio: 0.32; 95% confidence interval: 0.26-0.39; P<0.001) and redo-CAS (odds ratio: 0.55; 95% confidence interval: 0.39-0.78; P=0.001) compared with primary-CAS. Similarly, the odds of hypotension were significantly lower in both groups compared with primary-CAS (CASAPICEA: 0.41 [0.35-0.48], P<0.001; redo-CAS: 0.66 [0.50-0.86] P=0.003). There were no significant differences in the hazards of stroke/death at 1 year for CASAPICEA and redo-CAS compared with primary-CAS.

CONCLUSIONS: CASAPICEA is associated with significantly lower odds of periprocedural stroke/death compared with primary-CAS among symptomatic patients. CASAPICEA and redo-CAS are associated with significantly lower odds of periprocedural hypotension and bradycardia but higher odds of hypertension compared with primary-CAS.

Original languageEnglish (US)
Pages (from-to)3086-3092
Number of pages7
JournalStroke
Volume48
Issue number11
DOIs
StatePublished - Nov 1 2017

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Angioplasty
Carotid Arteries
Carotid Endarterectomy
Stroke
Odds Ratio
Confidence Intervals
Bradycardia
Hypotension

Keywords

  • angioplasty
  • bradycardia
  • hypertension
  • hypotension
  • stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Arhuidese, I. J., Rizwan, M., Nejim, B., & Malas, M. (2017). Outcomes of Primary and Secondary Carotid Artery Stenting. Stroke, 48(11), 3086-3092. https://doi.org/10.1161/STROKEAHA.117.016963

Outcomes of Primary and Secondary Carotid Artery Stenting. / Arhuidese, Isibor J.; Rizwan, Muhammad; Nejim, Besma; Malas, Mahmoud.

In: Stroke, Vol. 48, No. 11, 01.11.2017, p. 3086-3092.

Research output: Contribution to journalArticle

Arhuidese, IJ, Rizwan, M, Nejim, B & Malas, M 2017, 'Outcomes of Primary and Secondary Carotid Artery Stenting', Stroke, vol. 48, no. 11, pp. 3086-3092. https://doi.org/10.1161/STROKEAHA.117.016963
Arhuidese IJ, Rizwan M, Nejim B, Malas M. Outcomes of Primary and Secondary Carotid Artery Stenting. Stroke. 2017 Nov 1;48(11):3086-3092. https://doi.org/10.1161/STROKEAHA.117.016963
Arhuidese, Isibor J. ; Rizwan, Muhammad ; Nejim, Besma ; Malas, Mahmoud. / Outcomes of Primary and Secondary Carotid Artery Stenting. In: Stroke. 2017 ; Vol. 48, No. 11. pp. 3086-3092.
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abstract = "BACKGROUND AND PURPOSE: Little is known of the excess risk attributable to secondary carotid angioplasty and stenting (CAS). This study evaluates outcomes of redo-CAS and CAS after prior ipsilateral carotid endarterectomy (CASAPICEA) relative to primary-CAS.METHODS: We studied all patients in the Vascular Quality Initiative, who underwent primary-CAS, CASAPICEA, or redo-CAS (2003-2016). Kaplan-Meier, multivariable logistic and Cox regression analyses were used to evaluate outcomes within 30 days and up to 1 year and identify their predictors.RESULTS: There were 11 742 CAS procedures performed: 8519 (72{\%}) primary-, 2645 (23{\%}) CASAPICEA, and 578 (5{\%}) redo-CAS. Comparing primary-CAS versus CASAPICEA versus redo-CAS, 30-day stroke/death was 2.5{\%} versus 2.0{\%} versus 1.3{\%} for asymptomatic patients (P=0.23) and 5.2{\%} versus 2.6{\%} versus 5.0{\%} for symptomatic patients (P=0.003). CASAPICEA was associated with significantly lower 30-day stroke/death (odds ratio: 0.60; 95{\%} confidence interval: 0.37-0.98; P=0.04) compared with primary-CAS among symptomatic patients. The odds of bradycardia were lower following CASAPICEA (odds ratio: 0.32; 95{\%} confidence interval: 0.26-0.39; P<0.001) and redo-CAS (odds ratio: 0.55; 95{\%} confidence interval: 0.39-0.78; P=0.001) compared with primary-CAS. Similarly, the odds of hypotension were significantly lower in both groups compared with primary-CAS (CASAPICEA: 0.41 [0.35-0.48], P<0.001; redo-CAS: 0.66 [0.50-0.86] P=0.003). There were no significant differences in the hazards of stroke/death at 1 year for CASAPICEA and redo-CAS compared with primary-CAS.CONCLUSIONS: CASAPICEA is associated with significantly lower odds of periprocedural stroke/death compared with primary-CAS among symptomatic patients. CASAPICEA and redo-CAS are associated with significantly lower odds of periprocedural hypotension and bradycardia but higher odds of hypertension compared with primary-CAS.",
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AU - Rizwan, Muhammad

AU - Nejim, Besma

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PY - 2017/11/1

Y1 - 2017/11/1

N2 - BACKGROUND AND PURPOSE: Little is known of the excess risk attributable to secondary carotid angioplasty and stenting (CAS). This study evaluates outcomes of redo-CAS and CAS after prior ipsilateral carotid endarterectomy (CASAPICEA) relative to primary-CAS.METHODS: We studied all patients in the Vascular Quality Initiative, who underwent primary-CAS, CASAPICEA, or redo-CAS (2003-2016). Kaplan-Meier, multivariable logistic and Cox regression analyses were used to evaluate outcomes within 30 days and up to 1 year and identify their predictors.RESULTS: There were 11 742 CAS procedures performed: 8519 (72%) primary-, 2645 (23%) CASAPICEA, and 578 (5%) redo-CAS. Comparing primary-CAS versus CASAPICEA versus redo-CAS, 30-day stroke/death was 2.5% versus 2.0% versus 1.3% for asymptomatic patients (P=0.23) and 5.2% versus 2.6% versus 5.0% for symptomatic patients (P=0.003). CASAPICEA was associated with significantly lower 30-day stroke/death (odds ratio: 0.60; 95% confidence interval: 0.37-0.98; P=0.04) compared with primary-CAS among symptomatic patients. The odds of bradycardia were lower following CASAPICEA (odds ratio: 0.32; 95% confidence interval: 0.26-0.39; P<0.001) and redo-CAS (odds ratio: 0.55; 95% confidence interval: 0.39-0.78; P=0.001) compared with primary-CAS. Similarly, the odds of hypotension were significantly lower in both groups compared with primary-CAS (CASAPICEA: 0.41 [0.35-0.48], P<0.001; redo-CAS: 0.66 [0.50-0.86] P=0.003). There were no significant differences in the hazards of stroke/death at 1 year for CASAPICEA and redo-CAS compared with primary-CAS.CONCLUSIONS: CASAPICEA is associated with significantly lower odds of periprocedural stroke/death compared with primary-CAS among symptomatic patients. CASAPICEA and redo-CAS are associated with significantly lower odds of periprocedural hypotension and bradycardia but higher odds of hypertension compared with primary-CAS.

AB - BACKGROUND AND PURPOSE: Little is known of the excess risk attributable to secondary carotid angioplasty and stenting (CAS). This study evaluates outcomes of redo-CAS and CAS after prior ipsilateral carotid endarterectomy (CASAPICEA) relative to primary-CAS.METHODS: We studied all patients in the Vascular Quality Initiative, who underwent primary-CAS, CASAPICEA, or redo-CAS (2003-2016). Kaplan-Meier, multivariable logistic and Cox regression analyses were used to evaluate outcomes within 30 days and up to 1 year and identify their predictors.RESULTS: There were 11 742 CAS procedures performed: 8519 (72%) primary-, 2645 (23%) CASAPICEA, and 578 (5%) redo-CAS. Comparing primary-CAS versus CASAPICEA versus redo-CAS, 30-day stroke/death was 2.5% versus 2.0% versus 1.3% for asymptomatic patients (P=0.23) and 5.2% versus 2.6% versus 5.0% for symptomatic patients (P=0.003). CASAPICEA was associated with significantly lower 30-day stroke/death (odds ratio: 0.60; 95% confidence interval: 0.37-0.98; P=0.04) compared with primary-CAS among symptomatic patients. The odds of bradycardia were lower following CASAPICEA (odds ratio: 0.32; 95% confidence interval: 0.26-0.39; P<0.001) and redo-CAS (odds ratio: 0.55; 95% confidence interval: 0.39-0.78; P=0.001) compared with primary-CAS. Similarly, the odds of hypotension were significantly lower in both groups compared with primary-CAS (CASAPICEA: 0.41 [0.35-0.48], P<0.001; redo-CAS: 0.66 [0.50-0.86] P=0.003). There were no significant differences in the hazards of stroke/death at 1 year for CASAPICEA and redo-CAS compared with primary-CAS.CONCLUSIONS: CASAPICEA is associated with significantly lower odds of periprocedural stroke/death compared with primary-CAS among symptomatic patients. CASAPICEA and redo-CAS are associated with significantly lower odds of periprocedural hypotension and bradycardia but higher odds of hypertension compared with primary-CAS.

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