The impact of carotid lesion calcification on outcomes of carotid artery stenting

Elsayed, Nadin; Yei, Kevin S.; Naazie, Isaac; Goodney, Philip P.; Clouse, W. Darrin; Malas, Mahmoud B.

doi:10.1016/j.jvs.2021.08.095

Cited by 25 publications

(12 citation statements)

References 32 publications

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“…However, the overall stroke risk in the standard-risk subset of patients undergoing either carotid revascularization procedure was low and within clinically acceptable periprocedural stroke rates. These findings warrant further investigative studies to clarify anatomic risk factors that may be associated with an increase in risk of stroke in carotid stenting, such as treatment of bulky or circumferentially calcified carotid lesions …”

Section: Discussionmentioning

confidence: 99%

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Risk of Stroke, Death, and Myocardial Infarction Following Transcarotid Artery Revascularization vs Carotid Endarterectomy in Patients With Standard Surgical Risk

et al. 2023

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ImportanceCarotid artery stenting has been limited to use in patients with high surgical risk; outcomes in patients with standard surgical risk are not well known.ObjectiveTo compare stroke, death, and myocardial infarction outcomes following transcarotid artery revascularization vs carotid endarterectomy in patients with standard surgical risk.Design, Setting, and ParticipantsThis retrospective propensity-matched cohort study was conducted from August 2016 to August 2019 with follow-up until August 31, 2020, using data from the multicenter Vascular Quality Initiative Carotid Artery Stent and Carotid Endarterectomy registries. Patients with standard surgical risk, defined as those lacking Medicare-defined high medical or surgical risk characteristics and undergoing transcarotid artery revascularization (n = 2962) or carotid endarterectomy (n = 35 063) for atherosclerotic carotid disease. In total, 760 patients were excluded for treatment of multiple lesions or in conjunction with other procedures.ExposuresTranscarotid artery revascularization vs carotid endarterectomy.Main Outcomes and MeasuresThe primary outcome was a composite end point of 30-day stroke, death, or myocardial infarction or 1-year ipsilateral stroke.ResultsAfter 1:3 matching, 2962 patients undergoing transcarotid artery revascularization (mean [SD] age, 70.4 [6.9] years; 1910 [64.5%] male) and 8886 undergoing endarterectomy (mean [SD] age, 70.0 [6.5] years; 5777 [65.0%] male) were identified. There was no statistically significant difference in the risk of the primary composite end point between the 2 cohorts (transcarotid 3.0% vs endarterectomy 2.6%; absolute difference, 0.40% [95% CI, −0.43% to 1.24%]; relative risk [RR], 1.14 [95% CI, 0.87 to 1.50]; P = .34). Transcarotid artery revascularization was associated with a higher risk of 1-year ipsilateral stroke (1.6% vs 1.1%; absolute difference, 0.52% [95% CI, 0.03 to 1.08]; RR, 1.49 [95% CI, 1.05 to 2.11%]; P = .02) but no difference in 1-year all-cause mortality (2.6% vs 2.5%; absolute difference, −0.13% [95% CI, −0.18% to 0.33%]; RR, 1.04 [95% CI, 0.78 to 1.39]; P = .67).Conclusions and RelevanceIn this study, the risk of 30-day stroke, death, or myocardial infarction or 1-year ipsilateral stroke was similar in patients undergoing transcarotid artery revascularization compared with those undergoing endarterectomy for carotid stenosis.

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Section: Discussionmentioning

confidence: 99%

“…These findings warrant further investigative studies to clarify anatomic risk factors that may be associated with an increase in risk of stroke in carotid stenting, such as treatment of bulky or circumferentially calcified carotid lesions. 19…”

Section: Discussionmentioning

confidence: 99%

Risk of Stroke, Death, and Myocardial Infarction Following Transcarotid Artery Revascularization vs Carotid Endarterectomy in Patients With Standard Surgical Risk

et al. 2023

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“…Carotid artery stenting through the occluded segment was thought to have difficulty obtaining satisfactory dilatation because of the severe circumscribed calcification. 7 Carotid endarterectomy was also thought to carry a significant risk. 8 We, therefore, decided to perform bridging bypass from the distal CCA to the proximal cervical ICA using a SVG without manipulating the occlusion site with circumferential bulky calcification.…”

Section: Discussionmentioning

confidence: 99%

A Case of Symptomatic Common Carotid Artery Occlusion Treated by a Bridging Bypass Using Short Saphenous Vein Graft

Yamamoto,

Iida,

Oka

et al. 2023

Asian J Neurosurg

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An 86-year-old woman with initially asymptomatic severe right common carotid artery stenosis had frequent transient left hemiparesis 2 years after the initial diagnosis. Magnetic resonance angiography and three-dimensional computed tomography angiography demonstrated short-segment occlusion of the right carotid bifurcation with significant circumferential calcification, while magnetic resonance imaging demonstrated no ischemic lesions. No collateral blood flow through the anterior communicating artery and posterior communicating artery was observed. A bridging bypass from the distal common carotid artery to the proximal cervical internal carotid artery using a saphenous vein graft was made. There were no ischemic symptoms following the procedure. Bridging bypass using the short saphenous vein graft might be useful for short-segment common carotid artery occlusion.

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“…48 However, a recent retrospective review of 11,342 patients from the VQI database suggests superiority of TCAR over TF-CAS in patients with greater than or equal 50% circumferential calcification. 49 Currently, the largest carotid stents available on the market are 10 mm in diameter, thereby limiting the treatment of carotid arteries larger than 9 mm. The results of carotid interventions have been extensively studied in symptomatic patients.…”

Section: Discussionmentioning

confidence: 99%

The Evolution of Current Management for Carotid Artery Bifurcation Disease

Zohourian

Hines

2022

Cardiology in Review

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Options for treatment of symptomatic carotid bifurcation disease include carotid endarterectomy (CEA) and carotid artery stenting (CAS). While over the years CEA has established itself as the gold standard for carotid artery revascularization, results from recent trials have shown CAS to be safe and effective in selected patients. This review details the evolution of carotid artery bifurcation disease by highlighting key clinical trials.

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The impact of carotid lesion calcification on outcomes of carotid artery stenting

Cited by 25 publications

References 32 publications

Risk of Stroke, Death, and Myocardial Infarction Following Transcarotid Artery Revascularization vs Carotid Endarterectomy in Patients With Standard Surgical Risk

Risk of Stroke, Death, and Myocardial Infarction Following Transcarotid Artery Revascularization vs Carotid Endarterectomy in Patients With Standard Surgical Risk

A Case of Symptomatic Common Carotid Artery Occlusion Treated by a Bridging Bypass Using Short Saphenous Vein Graft

The Evolution of Current Management for Carotid Artery Bifurcation Disease

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