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

Abstract

Background and Purpose— Guidelines recommend that carotid endarterectomy should be performed within 2 weeks in patients with a symptomatic carotid stenosis. Because a Swedish register study indicated that patients treated within the first days after a stroke or transient ischemic attack might have an increased perioperative stroke and mortality risk, this study aimed to find out whether these findings are also true under everyday conditions in Germany. Methods— Secondary data analysis including 56 336 elective carotid endarterectomy procedures performed for symptomatic carotid stenosis under everyday conditions between 2009 and 2014. The patient cohort was divided into 4 groups according to time interval between index event and surgery (I: 0–2, II: 3–7, III: 8–14, and IV: 14–180 days). Primary outcome was any in-hospital stroke or death. For risk-adjusted analyses, a multilevel multivariable regression model was used. Results— Mean patients’ age was 71.1±9.6 years; 67.5% were men. Overall rate of any stroke or death was 2.5% (n=1434). Risk of any in-hospital stroke or death was 3.0% in group I, 2.5% in group II, 2.6% in group III, and 2.3% in group IV. Multivariable regression analysis revealed that the time interval was not significantly associated with the primary outcome. Conclusions— The time interval between the index event and carotid endarterectomy was not associated with the risk of any in-hospital stroke or death in patients with symptomatic carotid stenosis in Germany. In clinically stable patients, carotid endarterectomy might, therefore, be performed safely as soon as possible after the neurological index event.

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

“…In this study no significant associations between time interval and the combined stroke and death risk were found. 8 Similar results could be found in multiple singlecenter studies with the same limitations of low statistical power as the single-center studies mentioned above. 18 Two other secondary data analysis studies found an increased 30day risk for any stroke or death only if the surgery was Figure 2.…”

“…Furthermore, all applied analytic methods are described in the methods section and have been described elsewhere as well. [8][9][10][11][12] Legal Basis of Data Acquisition Between 2009 and 2015 the aQua Institute was commissioned and authorized by the German Federal Joint Committee (legal basis §91 German Social Security Code part 5, SGB V 11 ) to develop and implement external quality assurance in the German healthcare system pursuant to §137a SGB V. The aQua Institute was also mandated for data validation, data analysis, and publication of annual quality reports. 13 In accordance with the German Federal Joint Committee directive concerning measures of transsectoral and inpatient quality assurance, 14,15 reporting of quality assurance data is compulsory for all reconstructive procedures on the extracranial carotid bifurcation.…”

“…Conformance with German data protection laws was verified by aQua Institute staff members (T.B.). [8][9][10][11][12]…”

“…Inclusion and exclusion criteria are provided in Figure 1. [8][9][10][11][12] The following variables were considered relevant to our study: time from the last neurologic event (=index event) to the procedure, age, sex, physical status (American Society of Anesthesiologists [ASA] stage), type of index event (AFX, TIA, minor/major stroke), degree of ipsi-and contralateral stenosis, periprocedural antiplatelet therapy, pre-and postprocedural neurologic assessment (performed by a specialist in neurology), intraprocedural neurophysiologic monitoring, procedural technique, use of an embolic protection device, duration of procedure, pre-and postprocedural diagnostic imaging (ultrasound, transcranial Doppler sonography,…”

Regional frequency variation of revascularization procedures for carotid stenosis in Germany

“…Secondary data analyses on specific questions, such as the link between age, gender, annual center volume, surgical technique, and the perioperative stroke and death rates have already been published [4–8]. Due to data protection regulations, it was not possible to carry out hospital-specific evaluations.…”