Short Time Interval Between Neurologic Event and Carotid Surgery Is Not Associated With an Increased Procedural Risk

Tsantilas, Pavlos; Kuehnl, Andreas; König, Thomas

doi:10.1016/j.jvs.2016.11.015

Cited by 18 publications

(37 citation statements)

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“…Using the same German nationwide database, we performed an analysis on all symptomatic patients treated by CEA (n=56 336). In this study no significant associations between time interval and the combined stroke and death risk were found . Similar results could be found in multiple single‐center studies with the same limitations of low statistical power as the single‐center studies mentioned above .…”

Section: Discussionsupporting

confidence: 89%

“…These patients would therefore be classified into the first time group (0‐2 days). Another explanation for the different findings could be the different end‐point definitions: the German study only assessed events until discharge, whereas the Swedish and UK studies assessed the 30‐day risks . However, how many strokes can be prevented by early treatment cannot be shown based on this secondary data analysis.…”

Section: Discussionmentioning

confidence: 94%

“…Controlled remote access to individual patient data was granted to our group, but we have also never had direct access to microdata. Furthermore, all applied analytic methods are described in the methods section and have been described elsewhere as well …”

Section: Methodsmentioning

confidence: 99%

“…No information on the time interval was available for 9 patients, who were therefore also excluded (N=4717). Inclusion and exclusion criteria are provided in Figure …”

Section: Methodsmentioning

confidence: 99%

“…The R extension packages gmodels , lme4 , and gam were used to calculate cross‐classified tables, chi‐squared tests, and multivariable regression analyses. The significance level for all statistical tests was set to α=0.05 …”

Section: Methodsmentioning

confidence: 99%

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Risk of Stroke or Death Is Associated With the Timing of Carotid Artery Stenting for Symptomatic Carotid Stenosis: A Secondary Data Analysis of the German Statutory Quality Assurance Database

Tsantilas

Kuehnl

Kallmayer

et al. 2018

JAHA

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BackgroundSubgroup analyses from randomized trials indicate that the time interval between the neurologic index event and carotid artery stenting is associated with periprocedural stroke and death rates in patients with symptomatic carotid stenosis. The aim of this article is to analyze whether this observation holds true under routine conditions in Germany.Methods and ResultsSecondary data analysis was done on 4717 elective carotid artery stenting procedures that were performed for symptomatic carotid stenosis. The patient cohort was divided into 4 groups according to the time interval between the index event and intervention (group I 0‐2, II 3‐7, III 8‐14, and IV 15‐180 days). Primary outcome was any in‐hospital stroke or death. For risk‐adjusted analyses, a multilevel multivariable regression model was used. The in‐hospital stroke or death rate was 3.7% in total and 6.0%, 4.4%, 2.4%, and 3.0% in groups I, II, III, and IV, respectively. Adjusted analysis showed a decreased risk for any stroke or death in group III, a decreased risk for any major stroke or death in groups III and IV, and a decreased risk for any death in groups II and III compared to the reference group I.ConclusionsA short time interval between the neurologic index event and carotid artery stenting of up to 7 days is associated with an increased risk for stroke or death under routine conditions in Germany. Although results cannot prove causal relationships, carotid artery stenting may be accompanied by an increased risk of stroke or death during the early period after the index event.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 94%

Section: Methodsmentioning

confidence: 99%

“…No information on the time interval was available for 9 patients, who were therefore also excluded (N=4717). Inclusion and exclusion criteria are provided in Figure …”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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